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Oxidative Medicine and Cellular Longevity
Volume 2, Issue 3, Pages 166-171

Phthalate Esters Used as Plasticizers in Packed Red Blood Cell Storage Bags May Lead to Progressive Toxin Exposure and the Release of Pro-Inflammatory Cytokines

1Swedish Medical Center, Trauma Research, Englewood, CO, USA
2Bonfils Blood Center, Denver, CO, USA
3St. Anthony Central Hospital, Trauma Services, Denver, CO, USA
4Swedish Medical Center, Trauma Services, Englewood, CO, USA
5Scott and White Hospital, Trauma Services, Temple, Texas, USA
6Swedish Medical Center, Emergency Department, Englewood, CO, USA

Received 27 March 2009; Revised 31 March 2009; Accepted 1 April 2009

Copyright © 2009 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Phthalate esters (PE's) are plasticizers used to soften PVC-based medical devices. PE's are the most abundant man-made pollutants and increase the risk of developing an allergic respiratory disease or a malignancy. The leaching of PE's in donated packed red blood cells (PRBC) during storage was assessed. PRBC transfusion bags containing CPD/AS-1 (ADSOL) buffer were analyzed. Samples were collected on storage day 1 and day 42. Two PE's, di-(2-ethylhexyl) phthalate (DEHP) and mono-(2-ethylhexyl) phthalate (MEHP), were measured by liquid chromatography coupled to mass spectrometry (LCMS). Interleukin-8 (IL-8) was measured by standard ELISA techniques. DEHP significantly increased from 34.3 µM (±20.0 SD) on day 1 to 433.2 µM (±131.2 SD) on day 42, a 12.6-fold increase. Similarly, MEHP significantly increased from 3.7 µM (±2.8 SD) on day 1 to 74.0 µM (±19.1 SD) on day 42, a 20.2-fold increase. Also, DEHP and MEHP increased the release of IL-8 from human umbilical vein endothelial cells (HUVEC). The transfusion of older units of PRBC could lead to an accumulation of PE's possibly resulting in inflammation and other effects. This accumulation could be exacerbated due to the decreased metabolism of PE's since trauma patients have a lower esterase activity, the enzymes responsible for metabolizing PE's. The effect of oxidative stress caused by PE's is discussed as a potential mechanism for increases in inflammation caused by older units of PRBC.