Blood storage bags and the tubing used to collect and store blood components contain di-(2-ethylhexyl) phthalate (DEHP). DEHP is a plasticiser used in many medical products and procedures that is flexible and also has a beneficial effect on red cells during storage, considerably increasing the shelf life.
DEHP is widespread in our environment, with every day exposure through food, plastic products, air and water. Phthalates, including DEHP, are in a huge number of common items, from plastic household products to food and drink containers, flooring, roofing, wall coverings, cables, paints, pharmaceutical products and clothing.
No significant adverse effects in humans from DEHP have been demonstrated in over 40 years of its use in medical procedures.
Use of PVC medical devices may lead to a higher exposure to DEHP compared to every day sources affecting the general population. Several procedures such as exchange transfusion of blood in neonates, extracorporeal membrane oxygenation (ECMO) treatment of neonates and adults, total parenteral nutrition (TPN) in neonates, haemodialysis, enteral nutrition in neonates and adults, heart transplantation or coronary artery bypass graft surgery, massive blood transfusion of red blood cells and plasma or peritoneal dialysis may lead to high exposure from DEHP potentially leaching from the device used. (1)
Because some blood bags and tubing contain DEHP, patients receiving blood products – especially those who are very small and/or receive a large number of transfusions – are at risk of exposure to DEHP. The Blood Service manages this risk by ensuring at-risk groups receive blood products that have been stored for the shortest possible time, as these have less DEHP.
The Blood Service continues to monitor research in potential DEHP alternatives. Whilst DEHP remains in use the small risk of DEHP exposure in blood transfusions should be considered in the context of the considerable benefits of the treatment.
- SCENIHR (Scientific Committee on Emerging and Newly-Identified Health Risks), Scientific Opinion on the safety of medical devices containing DEHP-plasticized PVC or other plasticizers on neonates and other groups possibly at risk. 2015