Effects of Red-Cell Storage Duration on Patients Undergoing Cardiac Surgery

Abstract

BACKGROUND Some observational studies have reported that transfusion of red-cell units that have been stored for more than 2 to 3 weeks is associated with serious, even fatal, adverse events. Patients undergoingcardiac surgery may be especially vulnerable to the adverse effects of transfusion. METHODS We conducted a randomized trial at multiple sites from 2010 to 2014. Participants 12 years of age or older who were undergoing complex cardiac surgery and were likely to undergo transfusion of red cells were randomly assigned to receive leukocyte-reduced red cells stored for 10 days or less (shorter-term storage group) or for 21 days or more (longer-term storage group) for all intraoperative and postoperative transfusions. The primary outcome was the change in Multiple Organ Dysfunction Score (MODS; range, 0 to 24, with higher scores indicating more severe organ dysfunction) from the preoperative score to the highest composite score through day 7 or the time of death or discharge. RESULTS The median storage time of red-cell units provided to the 1098 participants who received red-cell transfusion was 7 days in the shorter-term storage group and 28 days in the longer-term storage group. The mean change in MODS was an increase of 8.5 and 8.7 points, respectively (95% confidence interval for the difference, −0.6 to 0.3; P = 0.44). The 7-day mortality was 2.8% in the shorter-term storage group and 2.0% in the longer-term storage group (P = 0.43); 28-day mortality was 4.4% and 5.3%, respectively (P = 0.57). Adverse events did not differ significantly between groups except that hyperbilirubinemia was more common in the longer-term storage group. CONCLUSIONS The duration of red-cell storage was not associated with significant differences in the change in MODS. We did not find that the transfusion of red cells stored for 10 days or less was superior to the transfusion of red cells stored for 21 days or more among patients 12 years of age or older who were undergoing complex cardiac surgery. (Funded by the National Heart, Lung, and Blood Institute; RECESS ClinicalTrials.gov number, NCT00991341.)

Stiffness increase of red blood cells during storage

“…Whether and how the stiffness of RBCs changes during storage has critical relevance to patient safety and treatment effectiveness in transfusion medicine 6,47 . RBCs over the storage process have been mechanically characterized in both stretching and folding modes, and different metrics for indicating RBC deformability were used 17,18,48 .…”

Biomarkers defining the metabolic age of red blood cells during cold storage

“…16 The clinical implication of "old" RBC units is a controversial issue, because results provided by retrospective studies and randomized clinical trials are not in agreement. [18][19][20][21][22][23][24][25][26][27] Even if the full clinical impact of the storage lesion 28 and, specifically, of this multiphase metabolic decay, remains to be elucidated, it can be argued that all the metabolomics studies performed so far showed almost complete overlap of metabolic profiles of RBCs stored in different storage additives, despite interlaboratory strategies and metabolomics platforms. 13 For these reasons, we believe that an underlying signature of the RBC storage lesion exists across various media solutions and processing techniques, and that it can be translated in biomarkers that define the metabolic stage of stored RBCs.…”

Blood Transfusions Correct Anemia and Improve Tissue Oxygenation in Surgical and Critically ill Patients

“…Consequently trial after trial are currently showing no differences between groups causing confusion and misinterpretation in the field especially in relation blood transfusions. For example another US trial published in the NEJM by Steiner et al (9) almost identical to the Koch study except that they used leuco-reduced blood, could not reproduce the Koch findings instead finding no difference in outcome when aged red blood cells were transfused in cardiac surgery patients (9). Lacroix et al (10) also could not reproduce the results in cardiac surgery concerning the age of red blood cells.…”