## 3 Results
### Evaluation of Hemolysis Using LDH  
For the evaluation of hemolysis, we assessed the RBC solution quality, especially for LDH, before and after the journey and after filtration. The state after filtration indicated the state of actual transfusion.  
5.1 Round-Trip to Kamigoto Hospital (with a UH): RBC Solution in the ATR Round Trip vs. No Trip (Stored at the Laboratory)  
Blood packs #1-1 and #2-1 were transported in the ATR to Kamigoto Hospital and back. The mean LDH of the transported RBC solution (#1-1 [64.0 \(\pm\) 2.9 U/L], #2-1 [40.8 \(\pm\) 0.5 U/L]) was significantly lower than the mean LDH of the RBC solution in storage (#1-2 [74.0 \(\pm\) 2.9 U/L]; #2-2 [66.5 \(\pm\) 5.2 U/L]) (\(p\) = 0.003 and \(p\) = 0.002, respectively). The mean LDH values remained the same after filtration (\(p\) = 0.0011 and \(p\) = 0.000, respectively). LDH values are presented in Table 3.  
5.2 Round-Trip to Kamigoto Hospital (with UH Flight): RBC Solution Using RBC Constar Ills for the Round-Trip Helicopter Flight vs. No Trip (Stored at the Laboratory)  
In the case of the UH, the method using Constar Ills did not affect the LDH levels (55.5 \(\pm\) 3.7 vs. 54.0 \(\pm\) 2.8 U/L; \(p\) = 0.543), and after filtration, RBC solutions stored at the laboratory had higher LDH values (52.8 \(\pm\) 2.5 vs. 65.8 \(\pm\) 5.2 U/L; \(p\) = 0.011).  
5.3 Round-Trip to Kamigoto Hospital (with UH Flight): RBC Solution Using RBC Cooler Type IIIs for the Outward Flight vs. No Trip (Stored at the Laboratory)  
After the trip, the LDH level of the RBC solution transported with the type IIIs (#5-2) was significantly higher than that of the stored solution (#5-3) (119.8 \(\pm\) 1.7 U/L vs. 94.0 \(\pm\) 1.8 U/L; \(p\) < 0.000). After filtration, the LDH level was not significantly different between the transported and stored samples (131.8 \(\pm\) 4.1 vs. 125.8 \(\pm\) 5.7 U/L; \(p\) = 0.14)  
5.4 Round-Trip to Sasebo (Left in Sasebo Instead of Going to Kamigoto Hospital; without UH Flight) vs. No Trip (Stored at the Laboratory)  
In #4, the transport by air and car to Sasebo had no significant impact on LDH levels and were similar (70.8 \(\pm\) 2.9 U/L vs. 70.0 \(\pm\) 1.2 U/L; \(p\) = 0.653) between RBC solution samples brought back from Sasebo without a helicopter and those stored at the laboratory. After filtration, there was also no difference between the samples (89.0 \(\pm\) 5.5 U/L vs. 84.8 \(\pm\) 7.5 U/L; \(p\) = 0.402).  
Lastly, the LDH of, in #5 brought from Sasebo was significantly lower (57.5 \(\pm\) 1.0 vs. 94.0 \(\pm\) 1.8 U/L; \(p\) = 0.001) than that of the sample stored at the laboratory. The findings were similar for the samples after filtration (71.0 \(\pm\) 3.9 vs. 125.8 \(\pm\) 5.7 U/L; \(p\) < 0.000).  
The results varied, but overall, the LDH levels of the RBC solutions stored at the laboratory were higher or the same as those of the transported samples. Initially, the RBC  
\begin{table}
\begin{tabular}{c c c c c c c c} \hline \hline \multirow{2}{*}{**Sample Number and RBC Solution Storage/Transport**} & \multirow{2}{*}{
\begin{tabular}{c} **Blood Glucose** \\ **(mg/dL)** \\ \end{tabular} } & **AST (U/L)** & **LDH (U/L)** & \multirow{2}{*}{**K (mEq/L)**} & \multirow{2}{*}{**Lactate (mg/dL)**} & \multirow{2}{*}{**Ammonia (ug/dL)**} \\  & & **After Trip** & **After Trip** & & & & \\  & & **(After Trip)** & **After Trip  
solution sandwiched by type III was found to have LDH levels and showed hemolytic activity, but after filtration, no difference was observed.