DRBCs are derived from 450 ml of whole blood collected in Citrate/Phosphate/Dextrose (CPD) or Citrate/Phosphate/Dextrose/Adenine (CPDA-1) collection bags. DRBCs can also be made from additive solution Red Blood Cell (RBC) units such as CPD/AS-1, CPD/AS-5 or CP2D/AS-3 if these are first centrifuged to concentrate the RBCs to hematocrit of about 75%. The RBCs are stored for up to 6 days at 1 – 6 °C before being frozen in a cryoprotectant (40% weight/volume glycerol) and stored in the frozen state at minus 65 °C or colder, for up to 10 years. 1

Once it is determined that they will be needed for transfusion, the frozen RBCs are thawed. They are then deglycerolized by sequential washing with hypertonic (12%) saline followed by normal (0.9%) saline mixed with 0.2% glucose. Following deglycerolization, units are re-suspended in AS-3 additive solution and stored at 1-6°C, until ready for transfusion. DRBCs must recover at least 80% of the RBCs present from the original unit. Units suspended in AS-3 are FDA-approved for transfusion for up to 14 days when processed on the Haemonetics Automated Cell Processor ACP215 (Figure 1), an FDA 510(k)-cleared, closed processing system device. DRBCs are licensed under the respective Service Blood Program licenses.1, 2 All U.S. hospital ships and amphibious warships (LHA, LHD, LPD) with DRBC have ACP215.