Clinical consequences of red cell storage in the critically ill

Abstract

Red cell (RBC) transfusions are a potentially life-saving therapy employed during the care of many critically ill patients to replace losses in hemoglobin to maintain oxygen delivery to vital organs. During storage, RBCs undergo a series of biochemical and biomechanical changes that reduce their survival and function. Additionally, accumulation of other biologic by-products of RBC preservation may be detrimental to recipients of blood transfusions. Laboratory studies and an increasing number of observational studies have raised the possibility that prolonged RBC storage adversely affects clinical outcomes. In this article, the laboratory and animal experiments evaluating changes to RBCs during prolonged storage are reviewed. Subsequently, the clinical studies that have evaluated the clinical consequences of prolonged RBC storage are reviewed. These data suggest a possible detrimental clinical effect associated with the transfusion of stored RBCs; randomized clinical trials further evaluating the clinical consequences of transfusing older stored RBCs are required.

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

“…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].…”

“…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 observational studies on the association between RBC storage and outcome in critically ill adults are difficult to interpret as they yield conflicting results [1,3]. 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.…”

l-carnitine as a Potential Additive in Blood Storage Solutions: A Study on Erythrocytes

“…Erythrocytes undergo various biochemical and structural changes that impair their oxygen-delivering capacity and trigger secondary reactions when stored [1][2][3]. These changes, collectively constituting the ''storage lesion'', are characterized by morphological, physiological, biochemical, metabolic and biomechanical changes.…”

Oxidation of proteins: Basic principles and perspectives for blood proteomics

“…For example, RBCs are typically exposed to continuous fluxes of ROS due to their function; platelets are exposed to ROS at sites of inflammation, where coagulation happens. Additionally, protein oxidation mechanisms are of particular interest in transfusion medicine, and have been hypothesised to be responsible for the "blood storage lesion" [34][35][36][37][38]. Whether blood product oxidation is due to exposure of blood to oxidizing agents during puncture, handling, and blood product preparation (e.g., pathogen inactivation procedures), or appears only during storage as a result of aging or stress is still unclear.…”