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February 13, 2026

Bacterial proliferation is comparable in red blood cell concentrates stored in DEHT / PAGGSM and DEHP / SAGM containers

Key Points

To evaluate bacterial growth in red blood cell concentrates stored in DEHT/PAGGSM compared to DEHP/SAGM containers.
Collected paired ABO-matched whole blood in DEHT/PAGGSM and DEHP/SAGM sets.
Produced red blood cell concentrates using a top/bottom buffy coat process.
Spiked samples with specific bacteria and stored at 1–6°C for 43 days.
Conducted weekly bacterial enumeration.
No differences in bacterial growth between DEHT/PAGGSM and DEHP/SAGM RBCCs.
Yersinia enterocolitica and Serratia liquefaciens reached high bacterial counts by day 14.
Cutibacterium acnes levels remained stable until day 43.
Listeria monocytogenes counts declined in DEHT/PAGGSM initially but stabilized similarly in both bags by day 43.

Abstract

Abstract Background and Objectives The European Union's ban on the use of di(2‐ethylhexyl) phthalate (DEHP) in medical devices will take effect in 2030. DEHP is a plasticizer in polyvinyl chloride blood bags that helps stabilize the red blood cell membrane during hypothermic red blood cell concentrate (RBCC) storage. Recent studies have shown that RBCCs have acceptable in vitro quality after storage in DEHP‐free containers (e.g., plasticized with di(2‐ethylhexyl) terephthalate DEHT and stored in phosphate‐adenine‐glucose‐guanosine‐saline‐mannitol PAGGSM additive solution). To complement quality data, in this study, we compared bacterial growth in RBCCs stored in either DEHT/PAGGSM or DEHP/saline‐adenine‐glucose‐mannitol (SAGM). Materials and Methods Paired ABO‐matched whole blood units were collected into DEHT/PAGGSM sets, pooled and split into one DEHT/PAGGSM and one DEHP/SAGM bag set. RBCCs were produced using a top/bottom buffy coat process, tested for baseline in vitro quality and sterility, and spiked with Yersinia enterocolitica , Serratia liquefaciens and Listeria monocytogenes (~10 2 CFU/mL) and Cutibacterium acnes (~10 3 CFU/mL) ( N = 3). RBCCs were stored at 1–6°C for 43 days and sampled weekly for bacterial enumeration. Bacterial counts were compared between DEHP/SAGM and DEHT/PAGGSM RBCCs over 43 days of storage. Results For Y. enterocolitica , S. liquefaciens and C. acnes , no differences in survival/growth between DEHP/SAGM and DEHT/PAGGSM RBCCs were observed. Y. enterocolitica and S. liquefaciens grew to 10 8 –10 9 CFU/mL by day 14, while C. acnes remained at 10 3 CFU/mL until day 43. L. monocytogenes counts declined in DEHT/PAGGSM compared to DEHP/SAGM RBCC on days 0–7, but bacterial loads were similar (~10 7 CFU/mL) in both bags by day 43. Conclusion These results suggest that the bacterial safety risk of RBCCs is not increased in DEHT/PAGGSM containers.

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