Background: During storage of blood, the red blood cells undergo shape changes which cause fragility and endothelial interaction leading to deterioration the quality of blood in blood banks.Objectives: The aim of this study is to determine the morphological changes in red blood cells during storage in blood banks. Material and Methods: In this experimental study, a total 20 healthy volunteers between 17 to 40 years blood donors-Blood bags were taken, ten from each center i.e. MMCTH blood bank Mardan and KTH blood bank Peshawar. The specimen analysis was done at IBMS (Institute of Basic Medical Sciences) of KMU (Khyber Medical University) Peshawar. The exclusion criteria were People with anemia, hepatitis B &C, HIV and syphilis. The duration of this study was six months. The inform consent was taken from each donor. The total blood 250 ml from vein in cubital fossa from each blood donor was collected in 250ml pediatric blood bag with CPDA-1 solution. Blood bags were put up in the blood bank at +2 to +6 °C and stored till 20 days. Blood specimen of about 5cc were collected in 5cc syringe from each blood bag on 0, 5th,10th ,15th and 20th day for following parameters and thin film red blood cell was prepared for examination by light microscope. Morphological changes in RBCs examined via light microscope as well as grading the RBCs status in the peripheral blood film, the occurrence of distorted RBC simply in random fields; such as +1(scored 1 to 5 altered RBC present in each field), +2 (an average of 6 to 15 altered RBC in each field), +3(16 to 25 altered RBC in each field) and +4(more than 25 altered RBC present in each field). The multi head light microscope NIKON eclipse 50 was used for examination of peripheral blood slide and we took images of randomly selected field. The image J software was used for slide examination.Results: The morphological analysis of red blood cells, count of 200 cells in each blood slide in randomly selected fields are: On day 0 the majority of cells were normally shaped (97.95±1.297 (mean±SD).With increasing storage time, the percentage of morphologically abnormal red cells rose sharply. Mean percentage of abnormal cells on day 5, 10, 15 and 20 was 28.80±10.00, 51.73±12.47, 64.78±14.66 and 68.10±7.92 respectively. This increase in percentage of abnormally shaped cells was significant as determined by one way ANOVA (p =0.001). There was a big difference of percentage of abnormal RBCs on day 0 and in = 5 to= 10 days and in = 15 to = 20 days of blood storage. The mean values of day 0 of abnormal cells was 2.05±1.297 (Mean ± Std. Deviation), abnormal cells in= 5 to= 10 days was 40.26± 16.101 (Mean ± Std. Deviation) and on day = 15 and in = 20 day was 66.44± 11.75. The mean difference from day 0 to day 20 was 63.93±10.45 (Mean ± Std. Deviation).The one way ANOVA was significant, P= 0.001.Conclusion: This study confirms the hematological and morphological changes, when blood stored at 2 °C to 6 °C for up to 21 days. The significant morphological changes were observed on 5th day of blood storage. These findings suggested that approximately a week old stored blood is as good as the fresh blood; however, significant morphological and biochemical changes begin to appear after the first week of storage and these changes aggravate with time. Hence in order to achieve best possible transfusion outcomes, stored blood up to one week can be utilized.
Hemoglobin Oxidation in Stored Blood Accelerates Hemolysis and Oxidative Injury to Red Blood Cells