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REPORT NO. 809

EFFECTS OF ENVIRONMENTAL TEMPERATURE ONSELECTED BLOOD SHIPPING CONTAINERS

(Interim Report)

by

Dailey W. McPeakLTC Charles E. Shields, MC

andLTC Frank R. Camp, Jr., MSC

Blood Transfusion DivisionUS ARMY MEDICAL RESEARCH LABORATORY

Fort Knox, Kentucky 40121

2 April 1969

Preservation Studies of Human BloodWork Unit No. 155

Combat SurgeryTask No. 00

Combat SurgeryDA Project No. 3A0621 IOA821

This document has been approved for public release and sale;its distribution is unlimited.

USAMRL REPORT NO. 809DA PROJECT NO. 3A0621 10A821

ABSTRACT

EFFECTS OF ENVIRONMENTAL TEMPERATURE ONSSELECTED BLOOD SHIPPING CONTAINERS

OBJECTIVE

Evaluation of tile protection aflorded blood wlhen packed in selected blood slipping containre :andsubjected to various environmental tenmpe¢atures.

METHODS AND PROCEDURES

Loaded blood shipping containers were preconditioned tio temperature ot 4"('. A Yellow SpringsSModel 47 eleven-point scannting teletherlionicter with thermistor probes was used it) measure the

temperature of the test uinits. The thermistor probes were placed inside the bag ncar the middle. CornerSunits, being the most exposed, were the monitoring units in these studies since they responded faster to

external environmsental changes thatn did the center units. "rctnlprature measurements were muadesimultaneously. Ice was weighed at die beginning of tile experiment and again when tile temperature in tiheco ;ter units reached 1011C. The climatic room was controlled within ±- 1.0oC at selected tomperamues.

* iRESULTS AND CONCLUSION

The relationship between temperature holding capacity of each type ol box versus time shows thilalthe standard cardboard box with insulating plustic insert is three times more effective dtan thme uinsulatedstandard container. Also. the presence of unmielted ice within the shipping container cannot be considered areliable sign of safe blood temperature. Thus, it would be more practical and safer io measure thetemperature of the blooxl in the box than to rely oil the ammint of nmnielled ice as a guide to bloodusability.

EFFECTS OF ENVIRONMENTAL TEMPERATURE ONSELECTED BLOOD SHIPPING CONTAINERS

INTRODUCTIONi

The thlerapeLLtic value of blood dates back to aintiquity, but translfusioi, in the modern Sense of thetern, became a reality only whien problemis with blood coagulatiot. agglutilation, hiclolysis and infectionsfollowing transfuision could be overcome. During World War 1, a spcilk blhod tranisfusion technique wasdeveloped t0rough the combined efforts of surgeons from Great Britain and the kUnit,'d States.

The g,'..''- practice was to collect the blood within a 6 to 8 mile area. haul it by ambul,'ce overrough 3•!1'is f.r storage in an icebox, to be used within 10 to 14 days, In contrast, present-day bloou, halikssupply blood. with a two. to threefold increase in shelf' life, to American and Allied armies manay thousandmiles away front the colleciing station. Yet, two major problems co•nmon to both blood banking periodsstill remain-.that of mechanical transport and maintenance of satisfactory storage tempneature.

For more than two decades, die standard acceptable maximum temperature that blood may reach andstill be considered of good quality is l10C. Work by Gibson, Parpart and others, immediately followingWorld War II, provided evidence supporting this as a safe temperature (I, 2). There are Several reportsindicating the need to maintain blood at low temperatures. Hughies-Jones, in 1958, measuredposttransfusion survival of erythrocytes stored at temperatures fluctuating from 4 to 10oC and found thesurvival reduced by 11 (6). At temperatures above 150C, Gibson reported markedly accelerateddeterioration of bood (2).

Concern for proper mechanical transport and maintenance of a safe temperature of the blood.combined with the misconception that plasma was an effective substitute for blo(o,, initially delayed thedevelopment of the whole blood batik concept (3, 4). Significant progress began. however, in 1942,Ifollowing the Allied invasion of North Africa. During this invasion, the problems of blood therapy weresharply brought to light when the high rate of casualties demonstrated the inadequacy of plasma as a wholeblood replacc"ment. The British were the first to recognize this and aided in developing an organized bloodbatik program for die Allied Forces involving transoceanic blood exchange between the United States andEuropean tIations.

Various blood shipping containers have been designed to protect the blood in transit. One of the firstcontainers was made of plywood and built by a field medical unit. The lid was attached to the box withcommon door hinges. Salvaged blankets were used as cushioning and insulation. Another shipper wan theChurch container which provided ample protection and refrigeration for the blood and was used primarilyin rail shipments. During World War II, the m.'mlite can was also used extensively. The can was normallypacked with 10 bottles of blood, 10 recipient sets, arid 10 pounds of wet ice. rhis system of refrigerationusually provided storage at 4 to 4.5(" for 40 hours at ambient teiipoeratures of 18 to 28oC. However. thecommon disadvanitages of many of these containers, particularly the mamrite can, were high cost, excessiveweight. and lack of durability.

As various shipping containers were designed, new transportation methods were developed, includingthe use of air delivery by cargo chutes (Fig. I). Recent advent of the helicopter as a niedical transportationtool has reduced the necessity of parachute supply. Other methods are still beilg devised to meet unusualsituations in which terraii, environmental conditions, and enemy forces may prevent tie landing of ahelicopter and the deliverance of blood and blood products by usual over-land transportation, includingparachutes. New types of cushioning material, particularly plastic sheets c 1ntaining trapped air bubbles.

wet 'C developed tlhat1 )Itidled sitII ictl Illit etIie l it I pelilil air delivery oI" whole , blood or lItov,,i plasiaby •ee1 fall 0,111)p withoill thie use it plat ute.s Ii, l:,utheimuoe. tie• iecniitiqv %tit • ie Itlodilied for us: withfi.x ed wintg :,ilrIt, a% t I el i.s helicolpters. adl I I as liceit t.vot-ed by IilIo s ill Viet 1:,11, (C1).

"Thie' other tni'tll ll•'tor ,e ilt\--th' t of tIiialtie. IMLIlt1:iililtf, bWood withinti a laith. nl row

temperatutir ralti: 5 gl•el••lallý a IItilloI Illuoblvi• except whIen' Ihle bWood IN being shipped. At the tlitle il"'

shil til•.it t l thl' I•,iI Il.liti.cal poItable Ich.igIi•tl,,iit wet ice, must ble added. Add itimi•i ice Iliay ble requireddu ring tihe tIil i citilhici the outside Ie• einpat ,i. is ex'ccssivc.• hil-it or tile limet iii traisit is itng.

InI cutnmitn blooid bantkinig opet at ions%. a shipping b~ox is nlorm ally packed Willii Is 5unit% o: hole hilsoodM0d, 1 1 ,.'.ii0N of' , Ice. Ihoigh the i," is i.rinallly tie tet1it•,lati it ha:is ulutel been used as ., Itiloito• o"

.4.tislactorV shipping ,emperamurev F i ,0l1111! ice N I '!1 preselit whleni thie shipmeni't was rece lvd. %u)le wo•,ldxp'ect tihe ItInI)pra ti•mrc to hiave heciti maintained at IltI'" or lower and the bhlood still be ,isable. The

puit'o. 01o t, is ieport is to pre¢'i.'i obs• ivations ti)lt thie anlol,,i t i)1c ' pre'se,,n(t the actual tetllt'1i11.i•.e oftihe blood units within .elected blood shipping. ct ontainers at vario ,O enviri•,titt , itt.lll t .'iperat,.res.

METHODS AND MATERIALS

The method for measuring the temperature of the individual units was cxamined first. Threethrmaistur probes were used. Two were placed inside tile bag with one near the top and the other near thebottom. The third was placed outside the bag near its center. Simultaneous measurements f'ro•n all threewere obtained amd values over time are shown in Fi•gure 2. The differences between the temperatures at the

I' EMV 26' 1,-~ C

binSid. lop

I |114n i .l B1 toonto .Oulitdo Middl*

0-

E

4

0 t Io i 20 25

Hours

Fig. 2. IlalUa iiiI if tltr'c prtobtes in ulij.

dhrve polsitionis were ileglieible and subsequent mon01itorinig was doiic with tine probe inside tile bag necar tilemiddle. Coriker unish. being thle Most e.Xpos.d respollded faster ito •external envimmllliia c•ahll$ges tihail didthe ceii.ter Uillits. as MIown ill Figure 3. and lh1us w•ere chlosetil s t•Il' l.picid 11ili111 ) I 0imli wr.

lt*.got tnviornmor, 26 *+ I C

to

SPeriph•.•al lempertlulto Overe,.

C4111toe temperature avoilott

0 odinos aof BOI - I -' 5'0 S t0 Is 20 25

HOURS

Fig. 3. Ten|1.raurl l'o, enter uitois versus frlile ulnits.

=3

SI

btlxe\ lit il tile e xpge runcil ut 41u termiliii ed ti the loird. ti our [mlii day. The uililmtitle a Iii tm. l r su weremo dplied .11iil lthe little fiIlgi tilet'a ii, i ul tile maii IN lediced 1011C Was collsdelemI eritlical. Ill atuitam'iitl, lite'w4:1011 kt 111L I l0,ic WaS iiiedsuired at tire herinitingui ol" tire expeihi' ilet and Wvhienlite :cmpe ACaltel leaictcue

Fig. 4. The there sh ipping boxes stud ied

RESULTS

F igure 5 jil' siiates tile pierfoImrua nce of the st andard box. wit hout inisulat ing ma terial il anl* C~~ivvirminiti~tut temperature ot'28'1C. Note that the temuperatulre 01 til blood had already reached the (Atlp ot'

thle w-calkvd safet) ziu:ic olf WIC0% by 10 hours. At tht i ttlie, 7 pounds of icc. or half the original amounit,wcie still presentl. ih~lorti the presence oft ice has been utsed it) indicate that tile box was still at a sf

* ~temlieratlmre ohf 101W or less. it is appaieiti that alter 10 hourms. despite the presence of ice, thse irmileratureof' lthe b~ou1 lead exceeded thre sale temiperature. lie addition, thre box was re-iced and thre temnperature il1the units was nrot reduced b\ lthe added 14 pounds of ice. The uinits remained at relatively tire samectvimperatusre. and thenI C0ntililied to warmithu ds. tire ice did niot actually cool thre blood.

4

I!.r

.IN If

%to SdO 0.- 0

4 I I I F I

o t h IS 50 55O t

Hours

FIt. . I'erl'orniatice of the standard box itn 28'3C enviroimemt,

Viguio 6 slows ihe advamage of additional inasulatioli afflorded by the insert at an cnviromnneowtaltcmrpelltumo• .01 ", oiA ld AI. t Ihe +arp diltfcre0w ill tinte rcquirvd for cah box to reach 1Ot•, A•inl.ntote that 9-5 poutds of ice il the stanldard box inlainetd ontmelled, Mortover. if the1 ratio of ice melting totm'ltlwrattarc rise contiiuied at the same ratc. the temporature would soion he over 2•0C ;end still containsinmelted icc.

INV. 30* C tt)-)

u•. Scoederd

I L

0 10 20 40 6 0

t~i•.6.Pc~++ ", 'It 01.*+he standurd box with an•d withoutinse•rt iln unme n~t•,+tgl.l

r -

In riv pi~> k' vip g 1IMIlit e of Wil Mr. th VYetA tile hum ,itli ilike omlillkl I '-%p 11't-W tJ tileblo od bdotki to'' q X . g Nil "II ý Ili '%, %%:i tle the Its,werI aod a1 Ieaviet littmla Ieil box pli sniied 0hW *dtbIL

lpitt 4 e I i o I fo .Is 1d 2-5 11' it, t. iepwctive% --a th ree. aw id ltW tI itd dvalit e. A ,- OA ~iI L oikeinp~ilmris %I it two[ li In Figolle eaiilly dqwsI litU aLIvlitare

too

u,. //V "

/ O/t

4L.

1 00 umdt

FiB, ~ ~ ~ #- regla shitpp",)1 )'tl•x'lla hphI o ing1 " bo

environ llmen of~ 3111Can•ld wit iIns'ert•l~l~ bx

DISCUSSION

Thiusih thle inlstructionls Ili the PiesellI .•jludaid box pF0sCfih0 10.-10l1$ at kai.Q O"VIVl 24 11011S., 411

motle often'l if' external Icltliplt.ltirles are• over .1.111 of 401)1", it is apparentl thatl Il1¢.. Itilukl'lilles Illay fadlo Imaintlain the units at a' safe temperattime. The rci:,liut~ihiip beteeii capaici•lii~il•i~•il.% of" tiidltype of box.x anld time shows tha:t tile standard catdhkn.,id hnx Willh ill,'Idillip lla i-'siC: ili,%lt is IIllt.V litle.%'

"10,•t efflective than• the ulnilnmlated conita•iner. Tlle finding1s tit' th1ese temlpera~ture¢ widic% wtitld in1dicathethat the effects iof e'Xern1al temperature•s cal be'st be inodiiv~d byv inotc cf-l'wiv' ituhulaioi. Ili.csll inilihulq

activities, requiring8 long8 distance shipm1u1t tif bltx~d, have a 11ced I'r t entipewtultl ptottetio)n, jild [Ile•i11scitio11 of the plastic liner has iprovidi.al anl ii1n111'diste ans•wer a, •1. .ti. ashe evxeni11l u,1•1111l

tempertl~ utes tolain relative'ly to11pi.tate,

The Itecrl#baliatio oftoi nmadeJ that tile presee of'" ice is satislacloty e.vidence,• as • 111,the 10111K-IJIu[of" the box is clea-rly in error. Tile presence• of nmclwllhd ice canno•t be conusidere•d a 1cliahle. signu ofI sale•

bht•xl tempevollure, lit addition. wet ice added it) the, cnt~imer did notlohwe.t tile te-npt1iuratit oI" h.e bh.twld

coutiwuuuf h) protect tile blood froml the ef'fects if both wartiin and cooling, file temlperature it" lhe

blto~d it, the shipping[ box can on11y becomen wamler. Thus. it would scUl practical aId im1portan1t ton102sUN thC RIT11xt~ature of tile blood iii the box because this te'nlperu.itut wo•uld represent tile' aciual

maxi~tlUrnl tllrpC111tive. A vairiety' of n1¢thoits exists Ifor mon•itoring temperatures; ho•wever, sbn1ply' pla-cing .a

iti

fhle mu, ' met ei, ieiek fhe |}'1_ t .iit , ll $ tlhe I 1t1ot, W• il d be a bell•t e'-,ilillt " ,.Ih1,1 $ he hie |t"I ICnep 1 1Itlo II thl

field 1h1il ell g till on tihe :illlttlllil ol' llm et ted ie. (ilhll 111416c ..•pIhI'tll% ile.u.ledirci, II~i |ll ,lvk-,Ille

lil'ee'•.•m ) Iyto Ieit speciall nceds involved iti Itoilg disial u we t JlI i l'ie . 1t1.l filh clitii l im dellverv' lctle dhL.11,011f!~ tin leuti tende i--m ili en rutted etctWrlttlie 1;1 ~c en t.i~ll e'., It wv i c tC II.11 al it, . ItLCO ) I'ltool kWL' rse.1% iii ti laelliteds.

LITERATURE CITED

I.- l.•iltt. , J. G ',. T. S lwk, V. 1), jlhk d W. C . I dea ekwk. Ihl , i ef t of Valrile lkllptillt11 ilt

litlthi •,ii ;111i. J. t'lin. I rIvc'. 74 7. I)4'7.

2. I'.trpti, Aithur K.. 1', Wt I-vo. 1rei, R. K i';paIit. ). K. Gipg itt A. Mt. Cliiw, Whole bhtr~iptewLi 'atin: A virobkttl ill poici al phy moleu ,~~ Alit mn t aip w, mmi% ill' tile pit ihIm ill bloiti l

J. RelP)rt. i.ttltm it ll stin•I•.y It the Slrgpcoitt. NATO. USA. 2 July"" 1003.

4. Medichadl )eparitrli, Ujitii Slates Arnmy. SurgenY ill Worki Wior II. Tle. P•is sio•mictl.flotf_

5. shields, Charles L. I). W. MNPkak, J. C. Rothwell, G. II. Steger, and F. I. ('amp, It.0i1ves••titnt o1 Mule'it01nik muid methods I't, ail delivry o' whole bhix-M and bltild procucts. Mill.

hied. 13.13: 014. 198; LSAMRL Rio-pnlt No, 762., Ft Knox, Ky. 1 JOI)I A) NoWI T77).

6. IhiJ' el, N. C. Nwi. iol•t' "d r:diis ut t•inpluiets between +1O0T eond ,2011. Atilt J.I favina t. 4: 249. 19.1$.,

7

UNCLAS3'Fii I)SecUtisy Classification

DOCUMENT CONTROL DATA - R I D(Se-.:itty dI..,lh'tion ao tetle. body ot absMrl Ind indexhln Aflnntation must be etered whomn the overall topea It Classifid)

I. ORIGINATING ACTIVITY (Coopa..u -111m) as. REPORT SIECURITY CLASSIPiCATI•-N

LIS Army Medical Researclh Laboralory UNCLASSIFII-DFort Knox, Kentucky 40121 as. GROUP

3. REPORT TITLE

IEFFECTS OF ENVIRONMIENTAL TEMPEiRATURIE' ON SELECTED BLOOD SHIPPING CONTAINERS

4. ODSCRIPTIVIE NOTES (7Ypo ofltept a•d lncIul.ve date&)

Interim ReportS. AUTHORISI (PliMt iMW.. mdC* Intlarl, Ilat•tflet)

Dailey W. McPeak, LTC Charles E. Shields, MC, and LTC Frank R. Camp. Jr., MSC

6. REPORT DATEL 7a. TOTAL NO. OF PAGES 17.NO. or REP'S

2 April 1969 7 ,,b 6M CONTRACT OR GRANT NO. M, ORIGINATOR'S RIEPORT NUT1MUERII

I. PRoEcT NO. 3A06211OA821 809

"Task No. 00 . OTHERIIRPORT NtorS (Any, ftw rnmber,•, otm a- be ***ImlS

d.Work Unit No. 15510. OIATRIUTION STATEMENT

This document has been approved for public release and sale; its distribulion is unlimited.

F II. SUPPLEMENTARY NOTES 12-. SPONSORING MILITARY ACTIVITY

US Army Medical Research and Development Co'.imandWashington, D. C. 20315

18. ASIRS•ACT

The relationship between temperature holding capacity of each type of box versus time shows that the standard cardDoard

box with insulating plastic insert is three times more effective than the uninsulaled standard container. Also, the presence of

unmelted ice within the shipping container cannot be considered a reliable sign of safe blood temp~erature. Thus, it would bemore practical and safer to measure the temperature of the bWood in the box than to rely on the a ,ount of umnelted ice as aguide to blood usability. (U)

DD .' *..|473 ago UNCLASSIFIED_• e. .. uvs m. a~v USE. UNCLASSIFIED*4cSrt~y •a~taticaut

UNCLASSIFIEDBe"udty ClasIlfleaton

KV OR LtIM A LqNK 8 LINK C

O ..L..] 'WR R@,L WT ROLE W

Blood shipping containers W

RefrigerationPackaging material (Air Cap)InsulationTemperatureTransportation

AG 4668-0-Army-Knox-Jul 69-315 UNCLASSIFIEDSscintty eksaal-u tst