Polyvinylchloride (
PVC) is used in blood component containers as well as in many other medical devices because it shows optimal inertness, durability, and resistance to heat and chemicals. However, the
polymer itself does not provide good handling characteristics or the necessary properties for red blood cell (RBC) survival.
PVC thus needs to be plasticized, and di-(2-ethylhexyl)phthalate (
DEHP) has been the most common
plasticizer to produce the required flexibility to
PVC. However,
DEHP has been found to leach out from the containers, causing toxic effects, as demonstrated mainly in rodents. It is considered to be a possible
carcinogen and suspected to also produce endocrine effects especially in young males. Although controversial, it is commonly accepted that in vulnerable patients such as newborns,
trauma patients, or pregnant women, high exposure to
DEHP should be avoided. The replacement of the common
PVC +
DEHP blood bags poses technical challenges due to the positive influence of the
DEHP molecules on the red blood cell (RBC) membrane, and thus it has been shown to affect RBC storage and survival after transfusion. Different approaches are thus being taken to find a suitable alternative to
DEHP for blood components bags. Environmentalists even favor the substitution of the
PVC to avoid not only the
plasticizers but even the other residues contained in the
polymer material. Consequently, whereas the simplest
solution is the substitution of the
DEHP by other
plasticizers, alternative
plasticizer-free materials are becoming explored. Even modifications of existing materials are being presented by some research groups, ranging from covering of the
DEHP-containing materials to
alloys or special additive solutions. Different strategies as well as the most promising approaches are presented in this review. In any case, the degree of stabilization of RBCs undergoing prolonged storage will dictate the final acceptance for such alternatives.