Association between length of storage of red blood cell units and outcome of critically ill children: a prospective observational study

Karam, Oliver; Tucci, Marisa; Bateman, Scot T.; Ducruet, Thiérry; Spinella, Philip C.; Randolph, Adrienne G.; Lacroix, Jacques

doi:10.1186/cc8953

Cited by 86 publications

(81 citation statements)

References 45 publications

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“…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%

“…In trauma patients, the risk for development of ARDS was significantly increased in patients who received transfusion of leukoreduced RBCs stored for longer than 14 days, and transfusion of red cells older that 28 days has also been associated with deep vein thrombosis and multiple organ [19,25]. Patients who received blood units stored for longer than 14 days there was a significantly greater incidence of multiple organ dysfunction syndrome (MODS), with respiratory dysfunction observed in 10% of the cases [26]. In a retrospective observational study, post-transfusion ALI/ARDS has been assessed in critically ill patients with sepsis.…”

Section: Clinical Relevancementioning

confidence: 99%

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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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Section: Clinical Evidencementioning

confidence: 99%

Section: Clinical Relevancementioning

confidence: 99%

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

Babaev

Pozzi

Hare

et al. 2014

JACCOA

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“…Currently, no study has specifically examined the effects of storage age in pediatric trauma patients, although studies indicate that blood transfusions in this patient population are associated with increased coagulability (12). Studies now indicate that certain subgroups may benefit from fresher blood, but more evidence is required before such a recommendation can be made (13,14).…”

mentioning

confidence: 96%

RBC Transfusions in Children Requiring Intensive Care Admission After Traumatic Injury*

Hassan

DeCou

Reischman

et al. 2014

Pediatric Critical Care Medicine

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“…The various changes that occur within both the RBC and storage media during ex vivo preservation have been collectively termed the RBC "storage lesion." Importantly, alterations that occur during the RBC storage process are believed potentially responsible for many of the adverse effects associated with blood product administration (2). Among these concerns is a potentially increased risk of transfusion-related acute lung injury (TRALI) (3)(4)(5)(6) as well as risk-adjusted mortality (7)(8)(9)(10).…”

mentioning

confidence: 99%

Fresh Red Blood Cell Transfusion and Short-Term Pulmonary, Immunologic, and Coagulation Status

Kor¹,

Kashyap²,

Weiskopf

et al. 2012

Am J Respir Crit Care Med

104

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Rationale: Transfusion-related pulmonary complications are leading causes of morbidity and mortality attributed to transfusion. Observational studies suggest an important role for red blood cell (RBC) storage duration in these adverse outcomes. Objectives: To evaluate the impact of RBC storage duration on shortterm pulmonary function as well as immunologic and coagulation status in mechanically ventilated patients receiving RBC transfusion. Methods: This is a double-blind, randomized, clinical trial comparing fresh (<5 d of storage) versus standard issue single-unit RBC transfusion in adult intubated and mechanically ventilated patients. The primary outcome is the change in pulmonary gas exchange as assessed by the partial pressure of arterial oxygen to fraction of inspired oxygen concentration ratio ( Since the first successful attempt at blood storage almost a century ago, advances in extracorporeal red blood cell (RBC) preservation have incrementally prolonged the viability of stored RBCs. With contemporary preservative solutions, the accepted duration of RBC storage has now been extended to 42 days (1). In the past two decades, there has been increased interest in the time-dependent changes in RBC quantity and quality during this storage period. The various changes that occur within both the RBC and storage media during ex vivo preservation have been collectively termed the RBC "storage lesion." Importantly, alterations that occur during the RBC storage process are believed potentially responsible for many of the adverse effects associated with blood product administration (2). Among these concerns is a potentially increased risk of transfusion-related acute lung injury (TRALI) (3-6) as well as risk-adjusted mortality (7-10). Multiple publications have suggested that these associations become more significant with increased duration of RBC storage (8,(11)(12)(13). In a database analysis, Koch and colleagues found an association of RBC storage duration with mortality in patients undergoing cardiac surgery (8). This association was largely driven by an increased rate of respiratory complications. However, the observational nature of this investigation and concerns over residual confounding preclude definitive statements regarding causality. Moreover, evidence to the contrary exists as well (14-17), and the impact of RBC storage duration on development of transfusion-related complications remains a matter of debate (18,19).While the majority of TRALI cases are believed to be the result of an interaction between donor anti-HLA or anti-leukocyte antibodies and the cognate antigen on recipient leukocytes (20), a second "two-hit" model for TRALI has also been described (21). This model suggests that in a "primed" host, infusion of Author Contributions: D.J.K. contributed to the acquisition of data, and analysis and interpretation of the study results. R.K. contributed to the study design and procedures and the acquisition of the data. R.B.W. contributed to the study conception and design as well as the interpretati...

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Association between length of storage of red blood cell units and outcome of critically ill children: a prospective observational study

Cited by 86 publications

References 45 publications

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

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

RBC Transfusions in Children Requiring Intensive Care Admission After Traumatic Injury*

Fresh Red Blood Cell Transfusion and Short-Term Pulmonary, Immunologic, and Coagulation Status

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