Association between duration of storage of transfused red blood cells and morbidity and mortality in adult patients: Myth or reality?

Department of Intensive Care Medicine, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, Brussels, Belgium.
Transfusion (Impact Factor: 3.23). 06/2009; 49(7):1384-94. DOI: 10.1111/j.1537-2995.2009.02211.x
Source: PubMed


The duration of red blood cell (RBC) storage before transfusion may alter RBC function and, therefore, influence the incidence of complications.
With a computerized literature search from 1983 to 2008, 27 studies reporting the relationship between age of transfused RBCs and physiologic variables or incidence of complications in adult patients were identified.
Three studies (one abstract only, two foreign language) were excluded. The 24 remaining studies were grouped according to the patient population: cardiac surgery (eight studies), colorectal surgery (three), intensive care unit (ICU; seven), and trauma (six). The studies were too heterogeneous to allow a formal meta-analysis. Twenty-one of the 24 studies were single-center, and 12 were retrospective. The number of patients was highly variable, ranging from 15 to 6002. In cardiac surgery, two studies reported an increased risk of mortality but had statistical limitations. In colorectal surgery, two studies that addressed the effect on postoperative infections in the same database but with different designs yielded conflicting results. In general ICU patients, two retrospective studies reported a significant correlation between length of RBC storage and microcirculatory alterations or mortality, but the results were not confirmed in subsequent prospective, double-blinded studies. In trauma, five studies reported a correlation between RBC age and development of infection, multiple organ dysfunction, or mortality.
From the currently available published data, it is difficult to determine whether there is a relationship between the age of transfused RBCs and outcome in adult patients, except possibly in trauma patients receiving massive transfusion.

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Available from: Michael Piagnerelli, Feb 04, 2014
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    • "Nevertheless, recent retrospective and controversial studies have brought about concerns on the suitability of longer stored EC units for transfusion purposes [4] [5]. It has indeed been stressed that the risk of exposure to long-stored red blood cells (RBCs) is exacerbated when dealing with certain categories of recipients, such as traumatized, postoperative, and critically ill patients [5]. However, it should be worth mentioning that early results from randomized double-blind clinical prospective trials have not hitherto indicated any statistically significant disadvantage of the administration of longer stored units in comparison to fresher blood [6] [7]. "
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    ABSTRACT: Erythrocyte concentrates (ECs) stored for transfusion purposes still represent a lifesaving solution in a wide series of clinically occurring circumstances, especially for traumatized and perioperative patients. However, concerns still arise and persist as to whether current criteria for collection and storage of ECs might actually represent the best case scenario or there might rather be still room for improvement. In particular, the prolonged storage of EC has been associated with the accumulation of a wide series of storage lesions, either reversible (metabolism) or irreversible (protein and morphology). Independent laboratories have contributed to propose alternative strategies, among which is the introduction of oxygen removal treatments to ECs. Convincing biochemical and preliminary clinical evidences have been produced about the benefits derived from the introduction of this practice. We, hereby, propose a rapid, efficient, and time-effective strategy for blood deoxygenation which might fit in current EC production chain. The proposed strategy resulted in the complete deoxygenation of red blood cell hemoglobin (pO2 < 0.0021 mmHg). A preliminary small-scale study about the application of the present method resulted in reduced hemolysis, decreased vesiculation, and limited alterations to the red blood cell morphology, as gleaned from flow cytometry and scanning electron microscopic analyses. Further in-depth and larger-scale investigations are encouraged.
    03/2013; 2013(3):896537. DOI:10.1155/2013/896537
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    • "Previous systematic reviews [9-11,13] and a meta-analysis conducted in critically ill patients [63] have been inconclusive. Recently, in a meta-analysis, including 21 studies, Wang et al. concluded that older stored blood was associated with an estimated OR for death of 1.16 (95% CI 1.07-1.24). "
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    ABSTRACT: Red blood cells (RBC) storage facilitates the supply of RBC to meet the clinical demand for transfusion and to avoid wastage. However, RBC storage is associated with adverse changes in erythrocytes and their preservation medium. These changes are responsible for functional alterations and for the accumulation of potentially injurious bioreactive substances. They also may have clinically harmful effects especially in critically ill patients. The clinical consequences of storage lesions, however, remain a matter of persistent controversy. Multiple retrospective, observational, and single-center studies have reported heterogeneous and conflicting findings about the effect of blood storage duration on morbidity and/or mortality in trauma, cardiac surgery, and intensive care unit patients. Describing the details of this controversy, this review not only summarizes the current literature but also highlights the equipoise that currently exists with regard to the use of short versus current standard (extended) storage duration red cells in critically ill patients and supports the need for large, randomized, controlled trials evaluating the clinical impact of transfusing fresh (short duration of storage) versus older (extended duration of storage) red cells in critically ill patients.
    Annals of Intensive Care 01/2013; 3(1):2. DOI:10.1186/2110-5820-3-2 · 3.31 Impact Factor
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    • "Several studies have identified the age of transfused packed red blood cell (PRBC) units as an independent risk factor for increased morbidity and mortality [1-4], including in the critical care setting [5,6]. The existence of contradictory studies [1,2,7,8], however, indicates that this is still a matter of conjecture which necessitates further research. "
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    ABSTRACT: Critical care patients frequently receive blood transfusions. Some reports show an association between aged or stored blood and increased morbidity and mortality, including the development of transfusion-related acute lung injury (TRALI). However, the existence of conflicting data endorses the need for research to either reject this association, or to confirm it and elucidate the underlying mechanisms. Twenty-eight sheep were randomised into two groups, receiving saline or lipopolysaccharide (LPS). Sheep were further randomised to also receive transfusion of pooled and heat-inactivated supernatant from fresh (Day 1) or stored (Day 42) non-leucoreduced human packed red blood cells (PRBC) or an infusion of saline. TRALI was defined by hypoxaemia during or within two hours of transfusion and histological evidence of pulmonary oedema. Regression modelling compared physiology between groups, and to a previous study, using stored platelet concentrates (PLT). Samples of the transfused blood products also underwent cytokine array and biochemical analyses, and their neutrophil priming ability was measured in vitro. TRALI did not develop in sheep that first received saline-infusion. In contrast, 80% of sheep that first received LPS-infusion developed TRALI following transfusion with "stored PRBC." The decreased mean arterial pressure and cardiac output as well as increased central venous pressure and body temperature were more severe for TRALI induced by "stored PRBC" than by "stored PLT." Storage-related accumulation of several factors was demonstrated in both "stored PRBC" and "stored PLT", and was associated with increased in vitro neutrophil priming. Concentrations of several factors were higher in the "stored PRBC" than in the "stored PLT," however, there was no difference to neutrophil priming in vitro. In this in vivo ovine model, both recipient and blood product factors contributed to the development of TRALI. Sick (LPS infused) sheep rather than healthy (saline infused) sheep predominantly developed TRALI when transfused with supernatant from stored but not fresh PRBC. "Stored PRBC" induced a more severe injury than "stored PLT" and had a different storage lesion profile, suggesting that these outcomes may be associated with storage lesion factors unique to each blood product type. Therefore, the transfusion of fresh rather than stored PRBC may minimise the risk of TRALI.
    Critical care (London, England) 02/2012; 16(1):R19. DOI:10.1186/cc11178 · 4.48 Impact Factor
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