Reexamination of the chromium-51-labeled posttransfusion red blood cell recovery method

Transfusion. 2019 Jul;59(7):2264-2275. doi: 10.1111/trf.15310. Epub 2019 Apr 19.


Background: The chromium-51-labeled posttransfusion recovery (PTR) study has been the gold-standard test for assessing red blood cell (RBC) quality. Despite guiding RBC storage development for decades, it has several potential sources for error.

Methods: Four healthy adult volunteers each donated an autologous, leukoreduced RBC unit, aliquots were radiolabeled with technetium-99m after 1 and 6 weeks of storage, and then infused. Subjects were imaged by single-photon-emission computed tomography immediately and 4 hours after infusion. Additionally, from subjects described in a previously published study, adenosine triphosphate levels in transfusates infused into 52 healthy volunteers randomized to a single autologous, leukoreduced, RBC transfusion after 1, 2, 3, 4, 5, or 6 weeks of storage were correlated with PTR and laboratory parameters of hemolysis.

Results: Evidence from one subject imaged after infusion of technetium-99m-labeled RBCs suggests that, in some individuals, RBCs may be temporarily sequestered in the liver and spleen immediately following transfusion and then subsequently released back into circulation; this could be one source of error leading to PTR results that may not accurately predict the true quantity of RBCs cleared by intra- and/or extravascular hemolysis. Indeed, adenosine triphosphate levels in the transfusates correlated more robustly with measures of extravascular hemolysis in vivo (e.g., serum iron, indirect bilirubin, non-transferrin-bound iron) than with PTR results or measures of intravascular hemolysis (e.g., plasma free hemoglobin).

Conclusions: Sources of measurement error are inherent in the chromium-51 PTR method. Transfusion of an entire unlabeled RBC unit, followed by quantifying extravascular hemolysis markers, may more accurately measure true posttransfusion RBC recovery.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenosine Triphosphate / blood
  • Adult
  • Blood Banks / methods
  • Blood Preservation / methods*
  • Blood Transfusion, Autologous
  • Chromium Radioisotopes*
  • Erythrocyte Transfusion*
  • Erythrocytes / physiology*
  • Female
  • Hemolysis
  • Humans
  • Liver / physiology
  • Male
  • Middle Aged
  • Spleen / physiology
  • Technetium
  • Time Factors


  • Chromium Radioisotopes
  • Technetium
  • Adenosine Triphosphate
  • Chromium-51