Frozen red cells for military and civil purposes Relevance, experiences and developments

Massive blood loss still remains the major cause of death on the battlefield. Meeting transfusion needs under wartime conditions presents a formidable, logistical challenge. Regardless of the actual usage, a shelf life of 35 days for red cells requires shipments at least once a month. This easily leads to either wastage (low or no usage) or shortage (usage higher than expected). The solution is to apply freezing methods, of which the high-glycerol method is the most widely used. After thawing, however, the glycerol needs to be removed. Moreover, the current shelf life after thawing and washing is currently limited to 14 days.
This thesis describes possibilities to increase the practical applicability of frozen red cells. Combining adjustments of the washing fluid and the glycerolization method leads to less red cell damage, increasing their postthaw shelf life to 28 days. Prefreeze treatment with substances that increase the red cell’s energy content well above physiological levels not only extends their postthaw shelf life to 35 days, but also maintains their oxygen delivery capacity at a significantly higher level during the first two weeks of postthaw storage. The important practical implications of this thesis are that the results facilitate operating a frozen blood bank, by minimizing the effects of a time consuming deglycerolization procedure. Thus, the ability to maintain a liquid, previously frozen, inventory of red cells creates the possibility to better meet unexpected operational demands, as is the case under battlefield conditions.