A Pilot Trial Evaluating the Clinical Effects of Prolonged Storage of Red Cells

Hébert, Paul C.; Chin‐Yee, Ian; Fergusson, Dean; Blajchman, Morris A.; Martineau, Raymond; Clinch, Jennifer; Olberg, Bernhard

doi:10.1213/01.ane.0000148690.48803.27

Cited by 137 publications

(172 citation statements)

References 29 publications

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“…The outcome of (some of) these studies are probably confounded by a lack of transfusion policy and the use of leukocyte-non-depleted RBC preparations. Our observations on lack of correlation between change in oxygenation, duration of MV or PICU stay and length of RBC storage are compatible with experimental and clinical data indicating no difference in regional or global indexes of tissue oxygenation, or patient outcome in critically ill adults with organ failure [4][5][6].…”

supporting

confidence: 89%

Length of storage of red blood cells does not affect outcome in critically ill children

et al. 2008

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Sir: Length of red blood cell (RBC) storage has been proposed a contributing factor to adverse outcome after RBC transfusion. This may be explained by an impaired ability to transport or deliver oxygen, or the presence of leukocytes in stored RBC preparations producing potential deleterious pro-inflammatory mediators or bioactive lipids [1]. We hypothesized that length of RBC storage might explain our previously observed independent association between RBC transfusion and increased mortality, duration of mechanical ventilation (MV) and length of paediatric intensive care unit (PICU) stay in critically ill children [2].For each time a patient was transfused in our previous study, length of RBC storage was retrieved from our hospital's blood bank [2]. Since we observed a dose-outcome relation between the number of RBC transfusions and mortality, we separately looked at single transfusion and multiple transfusions. The effect of RBC transfusion on oxygenation was assessed by the oxygenation index (OI, mean airway pressure times FiO 2 divided by PaO 2 ) and PaO 2 /FiO 2 ratio. RBC preparations were leukocyte-depleted, but not irradiated. Statistical analysis was performed using the Student t-test; linear regression analysis was applied to study correlations. P \ 0.05 was accepted as statistically significant.Data of 295 patients were studied, of whom 67 (22.7%) were transfused; 39 (58.2%) were transfused only once, the remaining 28 received multiple transfusions at different time intervals (range 2-14) (Table 1). Seventeen (5.8%) patients died. The mean length of RBC storage was 16.7 ± 0.6 days [25-75% interquartile range (IQR) 9-23 days]. Length of RBC storage was comparable between survivors and non-survivors. This remained after comparing single versus multiple transfusions. Differences in OI and PaO 2 /FiO 2 ratio between the first day and fifth day after transfusion, duration of MV and length of PICU stay were not correlated with length of RBC storage.Our findings indicate that our previous reported observed independent association between transfusion of leucocyte-depleted RBC preparations and increased morbidity in critically ill children could not be explained by length of RBC storage. Mortality was also not influenced by length of RBC storage, although our study might not be powered to detect this. To our knowledge, although the issue of RBC transfusion has been extensively studied in critically ill adults, no other paediatric data on length of RBC storage and outcome in critically ill children have been reported. Results from retrospective and prospective Mean length of RBC storage (days ± SEM) 14.7 ± 1.4 13.5 ± 3.0 15.8 ± 1.5 16.0 ± 3.5 DOI difference in oxygenation index, DPaO 2 /FiO 2 difference in PaO 2 /FiO 2 ratio, RBC red blood cell, SEM standard error of the mean Intensive

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confidence: 89%

Length of storage of red blood cells does not affect outcome in critically ill children

et al. 2008

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“…with cardiac surgery, sepsis, and other critical illness [6,[18][19][20]. Vlaar et al [15] conducted a case-control study to identify risk factors associated with incidences of TRALI in a cohort of critically-ill patients.…”

Section: Demographicsmentioning

confidence: 99%

“…Most clinical studies of TRALI have been conducted in operating rooms and ICU, in the form of prospective and retrospective case-control data analyses in critically ill patients in many different settings (Table 2) [3][4][5][17][18][19]21,23,25,26]. Koch et al [27] have primarily examined the effects of transfusion on cardiac patients, observing significant increase in respiratory insufficiency and necessity for mechanical ventilation after transfusion of older RBC units [3,27].…”

Section: Clinical Evidencementioning

confidence: 99%

Storage of Red Blood Cells and Transfusion-Related Acute Lung Injury

Babaev

Pozzi

Hare

et al. 2014

JACCOA

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Transfusion-related acute lung injury (TRALI) is a major complication posttransfusion. A consensus definition of TRALI has been recently established to improve diagnosis but the pathogenesis of TRALI is yet to be understood. Although the antibody-mediated two-hit model of TRALI is the classical narrative, increasing evidence of the probable implications of prolonged storage of blood provides novel mechanisms towards storage lesion-the potentially injurious cellular and biochemical changes that occur in stored red blood cells. Red blood cell-derived lipids and micro vesicles may have been playing an important role in the development of TRALI. This article will provide a brief overview of the current understanding of TRALI and then discuss the implications and the potential mechanisms by which stored red blood cells may lead to TRALI. TRALI is characterized by clinical features that include, but not limited to, dyspnea, tachypnea, respiratory insufficiency, noncardiogenic bilateral pulmonary edema, decreased pulmonary compliance and acute hypoxemia (PaO 2 /FiO 2 <300 mmHg, (Table 1) [13,14]. KeywordsThe incidence of TRALI ranges from 1/5,000-1/1,323 transfusions within the general population and it is the leading cause of transfusion-related death in the United States [15]. Such large range in incidence could be attributed to the relatively unspecific diagnostics tools available for TRALI, past cases of under-diagnosis or misdiagnosis, and the elevated incidence of TRALI within vulnerable populations [14][15][16]. A recent study analyzing the incidence of TRALI in critically ill patients admitted to intensive care unit (ICU) observed that over 5% of all patients who received blood transfusion developed TRALI, which is 50-100 times greater occurrence than in the general hospital population [12,17]. Risk factors related to recipients and donorsThe risk factors of TRALI are highly diverse, among patients DefinitionDiagnostic Parameters TRALIBi-lateral infiltrates with non-cardiogenic pulmonary edema. ARDS appearance within 6hours after transfusion. Hypoxemia: PaO 2 /F i O 2 < 300 mmHg. Potential TRALI Similar to TRALI diagnosis with an additional risk-factor for lung injury/ARDS. Delayed TRALI Diagnostic parameters characteristic of TRALI within 24-72 hours after transfusion.

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“…Because of the importance of the original Marik and Sibbold study in the debate over the quality of stored red blood Patients receiving older blood had longer ICU stay but did not have a higher need for ICU care [51] Randomized trial of RBC < 10 or > 10 days in surgical and critically ill patients This largest well-conducted retrospective review found no association [53] Review of registry of all repeat midline sternotomy patients for CABG, valve, or both 321 Age of RBCs, associated in a regression model with in-hospital and out-of-hospital mortality Age of red blood cells, associated in a regression model with in-hospital and out-of-hospital mortality cells, Walsh and his colleagues at the Edinburgh Royal Infirmary reported a randomized, prospective double blind trial in 2004 [48]. Twelve patient volunteers in septic shock were randomized to receive transfusions with red blood cells stored for greater than 20 days, and 10 more were given red blood cells stored for less than 5 days.…”

Section: Data From Clinical Studiesmentioning

confidence: 99%

“…At about the same time, Hebert and his colleagues in the Canadian Critical Care Trials Group published the results of a multicentre randomized pilot study of 66 cardiac surgery and critical care patients randomized to receive either red blood cells stored less than 8 days or standard blood bank issue red blood cells that would usually have longer storage because of first-in-first-out practices [51]. Nine patients did not require any red blood cells, but among the 57 patients who did, the mean durations of storage were 4 and 19 days.…”

Section: Data From Clinical Studiesmentioning

confidence: 99%

Current issues relating to the transfusion of stored red blood cells

Zimrin¹,

2009

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The development of blood storage systems allowed donation and transfusion to be separated in time and space. This separation has permitted the regionalization of donor services with subsequent economies of scale and improvements in the quality and availability of blood products. However, the availability of storage raises the question of how long blood products can and should be stored and how long they are safe and effective. The efficacy of red blood cells was originally measured as the increment in haematocrit and safety began with typing and the effort to reduce the risk of bacterial contamination. Appreciation of a growing list of storage lesions of red blood cells has developed with our increasing understanding of red blood cell physiology and our experience with red blood cell transfusion. However, other than frank haemolysis, rare episodes of bacterial contamination and overgrowth, the reduction of oxygen-carrying capacity associated with the failure of some transfused cells to circulate, and the toxicity of lysophospholipids released from membrane breakdown, storage-induced lesions have not had obvious correlations with safety or efficacy. The safety of red blood cell storage has also been approached in retrospective epidemiologic studies of transfused patients, but the results are frequently biased by the fact that sicker patients are transfused more often and blood banks do not issue blood products in a random order. Several large prospective studies of the safety of stored red blood cells are planned.

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A Pilot Trial Evaluating the Clinical Effects of Prolonged Storage of Red Cells

Cited by 137 publications

References 29 publications

Length of storage of red blood cells does not affect outcome in critically ill children

Length of storage of red blood cells does not affect outcome in critically ill children

Storage of Red Blood Cells and Transfusion-Related Acute Lung Injury

Current issues relating to the transfusion of stored red blood cells

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