Fresh Blood and Aged Stored Blood Are Equally Efficacious in Immediately Reversing Anemia-induced Brain Oxygenation Deficits in Humans

Weiskopf, Richard B.; Feiner, John; Hopf, Harriet W.; Lieberman, Jeremy A.; Finlay, Heather E.; Quah, Cheng; Kramer, Joel H.; Bostrom, Alan; Toy, Pearl

doi:10.1097/00000542-200605000-00005

Cited by 154 publications

(114 citation statements)

References 51 publications

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“…Weiskopf and colleagues have reported similar efficacy in reversing anemia-induced neurocognitive deficits with both fresh (storage, 3.5 h) and stored (storage, 3 wk) RBCs (43). Similarly, Walsh and colleagues noted similar effects of RBC transfusion on both regional and global markers of oxygenation when comparing fresh RBCs (stored <5 d) with RBCs that had undergone more prolonged storage (stored >20 d) (44).…”

Section: Discussionmentioning

confidence: 87%

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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Section: Discussionmentioning

confidence: 87%

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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“…32 Tissue hypoxia occurs in healthy adults at hemoglobins as low as 5 to 6 g/dL (hematocrits of 15 to 18). 33,34 This level of anemia is considerably lower than commonly tolerated by physicians when managing their cardiac surgery patients (typically hematocrits of 24 to 26). More restrictive transfusion thresholds (eg, hematocrit of 21) have been shown to be beneficial in critically ill noncardiac surgical patients in a randomized trial.…”

Section: Findings In the Context Of The Literaturementioning

confidence: 99%

Increased Mortality, Postoperative Morbidity, and Cost After Red Blood Cell Transfusion in Patients Having Cardiac Surgery

et al. 2007

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Background-Red blood cell transfusion can both benefit and harm. To inform decisions about transfusion, we aimed to quantify associations of transfusion with clinical outcomes and cost in patients having cardiac surgery. Methods and Results-Clinical, hematology, and blood transfusion databases were linked with the UK population register.Additional hematocrit information was obtained from intensive care unit charts. Composite infection (respiratory or wound infection or septicemia) and ischemic outcomes (myocardial infarction, stroke, renal impairment, or failure) were prespecified as coprimary end points. Secondary outcomes were resource use, cost, and survival. Associations were estimated by regression modeling with adjustment for potential confounding.

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“…The condition is exacerbated when the patient receives large volume of RBCs of whole blood. [18], [9]. The plasma level of potassium may increase by 0.5-1.0mmol/L per day of refrigerator storage [19].There is a notion that the total amount of extracellular potassium in a unit of blood stored for 35days falls within 7mmol/L to 25mmol/L [20].…”

Section: Discussionmentioning

confidence: 99%

Storage Effect on Serum Electrolytes and pH in Whole Blood Stored in Traditional Refrigerator

2016

IJSR

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Fresh Blood and Aged Stored Blood Are Equally Efficacious in Immediately Reversing Anemia-induced Brain Oxygenation Deficits in Humans

Abstract: Erythrocytes stored for 3 weeks are as efficacious as are erythrocytes stored for 3.5 h in reversing the neurocognitive deficit of acute anemia. Requiring fresh rather than stored erythrocytes for augmentation of oxygen delivery does not seem warranted.

Cited by 154 publications

References 51 publications

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

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

Increased Mortality, Postoperative Morbidity, and Cost After Red Blood Cell Transfusion in Patients Having Cardiac Surgery

Storage Effect on Serum Electrolytes and pH in Whole Blood Stored in Traditional Refrigerator

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