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. 2013 Mar;53(3):606-11.
doi: 10.1111/j.1537-2995.2012.03765.x. Epub 2012 Jun 28.

Frequency of glucose-6-phosphate Dehydrogenase-Deficient Red Blood Cell Units in a Metropolitan Transfusion Service

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Free PMC article

Frequency of glucose-6-phosphate Dehydrogenase-Deficient Red Blood Cell Units in a Metropolitan Transfusion Service

Richard O Francis et al. Transfusion. .
Free PMC article

Abstract

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is characterized by red blood cell (RBC) destruction in response to oxidative stress. Although blood donors are not routinely screened for G6PD deficiency, the transfusion of stored G6PD-deficient RBCs may have serious adverse outcomes. By measuring G6PD enzyme activity of RBC units from a large metropolitan hospital transfusion service, we sought to determine 1) the prevalence of G6PD-deficient RBC units, 2) if G6PD activity changes during storage, and 3) if G6PD activity in segments correlates with its activity in the bags.

Study design and methods: Quantitative G6PD activity was measured in 301 randomly selected RBC units and 73 D+C-E- (i.e., R r or R R ) RBC units, all stored in additive solutions. G6PD deficiency was defined as activity less than 60% of the normal mean.

Results: The frequency of G6PD-deficient units in the general inventory was 0.3% (1/301; 95% confidence interval [CI], <0.01%-2.1%). In contrast, its frequency in D+C-E- RBC units was 12.3% (9/73; 95% CI, 6.4%-22.0%). G6PD activity did not significantly change during the 42-day storage period, and G6PD activity measured in RBC storage bags and attached segments correlated well (r=0.7-0.9, p ≤ 0.001, Spearman rank correlation).

Conclusions: Although the frequency of G6PD-deficient RBC units in the transfusion service general inventory was relatively low, it was significantly higher among a subset of R r or R R units. The latter are preferentially allocated for transfusion to patients with sickle cell disease to decrease the risk of RBC alloimmunization, possibly allowing more of these units to be inadvertently targeted to these patients.

Conflict of interest statement

Conflicts of Interest Disclosure: The authors declare that they have no conflicts of interest relevant to the manuscript submitted to TRANSFUSION.

Figures

Figure 1
Figure 1. Correlation of G6PD activity measured in pRBC storage bags and attached segments
RBC G6PD activity was measured in the storage bags and the attached segments from discarded pRBC units (n=37) that were obtained following erythrocytapheresis procedures. The storage age of these units ranged from 5 to 27 days. Seventeen of these units were known to have a phenotype of D+, C-, E-, and 3 of these 17 units were G6PD-deficient.
Figure 2
Figure 2. G6PD activity during RBC storage
a. Cross-sectional study of G6PD activity in 161 randomly-selected pRBC units in the general inventory. G6PD activity was measured in the attached segments of units selected for the following storage intervals: Day 7 (n=32), 14 (n=33), 21 (n=33), 28 (n=30), 35 (n=17), and 42 (n=16). Mean activities at each time-point were compared using the Kruskal-Wallis test. There was no significant difference in G6PD activity during the storage period examined (p=0.4). One unit selected at 28 days of storage was identified as G6PD deficient. b. Longitudinal study of G6PD activity in 16 purchased pRBC units (bags and segments), serially measuring activities beginning at Day 5 or 6 of storage and ending at Day 42. There was no significant difference in G6PD activity between day 5 or 6 and day 42 of storage in bags (p=0.3, paired t test) or segments (p=0.2, paired t test). ns=not significant.

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