Red blood cells stored 35 days or more are associated with adverse outcomes in high‐risk patients

Goel, Ruchika; Johnson, Daniel J.; Scott, Andrew V.; Tobian, Aaron A.R.; Ness, Paul M.; Nagababu, Enika; Frank, Steven M.

doi:10.1111/trf.13559

Cited by 86 publications

(78 citation statements)

References 56 publications

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“…Use of these databases and quality control methods were described previously. 20,21 Of the 451 patients that underwent RC during this time period, 52% (233/451) received PBTs. The standard of care at Johns Hopkins Hospital is to transfuse with leukoreduced PBTs.…”

Section: Methodsmentioning

confidence: 97%

“…Morbid events were defined as (1) infection, (2) thrombotic event (deep venous thrombosis, pulmonary embolus, or disseminated intravascular coagulation), (3) renal event (acute renal failure, oliguria/anuria, or urinary tract infection), (4) respiratory event (pneumonia or respiratory failure), and (5) ischemic event (myocardial infarction, transient ischemic attack, or cerebrovascular accident), which is consistent with previous studies. 20,21 Data to classify morbid events were obtained through the hospital’s billing database, using ICD-9 codes as a validated, prospective method to collect information on in-hospital complications. 22,23 Conditions flagged as present on admission were not considered to be “in hospital/acquired” morbid events.…”

Section: Methodsmentioning

confidence: 99%

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Longer average blood storage duration is associated with increased risk of infection and overall morbidity following radical cystectomy

Chappidi

Chalfin

Johnson

et al. 2017

Urologic Oncology: Seminars and Original Investigations

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Background Bladder cancer patients undergoing radical cystectomy experience high rates of perioperative blood transfusions and morbidity. The aim of this study was to evaluate the impact of blood storage duration on the risk of adverse perioperative outcomes in this high-risk patient population. Materials and Methods In a retrospective review of radical cystectomy patients from 2010–2014 that received perioperative blood transfusions, the average storage duration for all units transfused was used to classify patients as receiving older blood using three different definitions (≥21 days, ≥28 days, and ≥35 days). Multivariable Poisson regression models were used to determine the adjusted relative risk of perioperative infections and overall morbidity in those given older blood compared to fresher blood. Results A total of 205/451(45%) patients undergoing radical cystectomy received non-irradiated, perioperative blood transfusions. In multivariable modeling, increasing average blood storage duration, as a continuous variable, was associated with an increased risk of infections (RR=1.08 per day, 95%CI 1.01–1.17) and overall morbidity (RR=1.08 per day, 95%CI 1.01–1.15). Furthermore, ≥28 day blood storage (vs. <28) was associated with increased infections (RR=2.69, 95%CI 1.18–6.14) and morbidity (RR=2.54, 95%CI 1.31–4.95), and ≥35 day blood storage (vs. <35) was also associated with increased infections (RR=2.83, 95%CI 1.42–5.66) and morbidity (RR=3.35, 95%CI 1.95–5.77). Conclusions Although blood is stored up to 42 days, storage ≥28 days may expose radical cystectomy patients to increased perioperative infections and overall morbidity compared to storage <28 days. Prospective cohort studies are warranted in cystectomy and other high-risk surgical oncology patients, to better determine the impact of blood storage duration.

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Section: Methodsmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

Longer average blood storage duration is associated with increased risk of infection and overall morbidity following radical cystectomy

Chappidi

Chalfin

Johnson

et al. 2017

Urologic Oncology: Seminars and Original Investigations

Self Cite

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“…First, it was a singlecenter study and results may be dependent on local transfusion and surgical practice. It was previously suggested that adverse effects are associated with RBCs stored for more than 35 days, 51 but in our hospital, RBCs are stored only up to 35 days. Thus, we were not able to explore the effects of RBCs stored for a longer period.…”

Section: Subgroup Analysismentioning

confidence: 99%

The effects of storage of red blood cells on the development of postoperative infections after noncardiac surgery

et al. 2017

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BACKGROUND: Prolonged storage of red blood cells (RBCs) is a potential risk factor for postoperative infections. The objective of this study was to examine the effect of age of RBCs transfused on development of postoperative infection. STUDY DESIGN AND METHODS: In thisprospective, double-blind randomized trial, 199 patients undergoing elective noncardiac surgery and requiring RBC transfusion were assigned to receive nonleukoreduced RBCs stored for not more than 14 days ("fresh blood" group, n 5 101) or for more than 14 days ("old blood" group, n 5 98). The primary outcome was occurrence of infection within 28 days after surgery; secondary outcomes were postoperative acute kidney injury (AKI), in-hospital and 90-day mortality, admission to intensive care unit, and hospital length of stay (LOS). As older blood was not always available, an "as-treated" (AT) analysis was also performed according to actual age of the RBCs transfused. RESULTS:The median [interquartile range] storage time of and 15 [11][12][13][14][15][16][17][18][19][20] days in fresh blood and in old blood groups, respectively. The occurrence of postoperative infection did not differ between groups (fresh blood 22% vs. old blood 25%; relative risk [RR], 1.17; confidence interval [CI], 0.71-1.93), although wound infections occurred more frequently in old blood (15% vs. 5%; RR, 3.09; CI,). Patients receiving older units had a higher rate of AKI (24% vs. 6%; p < 0.001) and, according to AT analysis, longer LOS (mean difference, 3.6 days; CI, 0.6-7.5).CONCLUSION: Prolonged RBC storage time did not increase the risk of postoperative infection. However, old blood transfusion increased wound infections rate and incidence of AKI. Immunosuppression induced by surgery and anesthesia may be aggravated by transfusion. 9 Most studies in trauma and cardiac surgery reported that prolonged RBC storage was a risk factor for postoperative infections after cardiac surgery, 10-12 but the same association was not found in liver transplantation 13 or orthopedic surgery. 14 A recent systematic review 15 that analyzed four trials which investigated the nosocomial infections, showed no benefits in receiving fresh RBCs. However, the authors reported that the results are difficult to interpret because the studies involved different populations and there were considerable differences in the length of storage of fresh and old blood and in study methods. 15To our knowledge, the association of age of RBCs with infections in noncardiac surgery population has not been investigated by double-blind randomized studies. Accordingly, the aim of this study was to investigate the relationship between RBC storage time and postoperative infection after elective noncardiac surgery. In addition, we evaluated the effects of the age of RBCs on other outcomes such as postoperative acute kidney injury (AKI), hospital length of stay (LOS), and 90-day mortality. MATERIALS AND METHODS Study populationThis prospective, randomized, controlled, double-blind clinical trial was conducted between August 2...

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“…One reason for this is that these studies have been limited by small sample sizes. Another reason is that the definition of fresh blood and aged blood has been inconsistent across studies ( Table 1) (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Several articles have defined fresh blood as a function of time, ranging anywhere from 5 days (8) to 21 days (17), while others have taken a more practical approach, employing a "freshest available" policy (18,20).…”

mentioning

confidence: 99%

“…The definition of aged blood has also suffered from wide variations. Notably, only one study to date has investigated the effect of pRBC units transfused in their last week of storage, observing adverse outcomes in high-risk patients (17).…”

mentioning

confidence: 99%

Age before duty: the effect of storage duration on mortality after red blood cell transfusion

2017

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Red blood cells stored 35 days or more are associated with adverse outcomes in high‐risk patients

Abstract: RBCs transfused in the last 7 days of their 42-day storage limit may be associated with adverse clinical outcomes in high-risk patients.

Cited by 86 publications

References 56 publications

Longer average blood storage duration is associated with increased risk of infection and overall morbidity following radical cystectomy

Longer average blood storage duration is associated with increased risk of infection and overall morbidity following radical cystectomy

The effects of storage of red blood cells on the development of postoperative infections after noncardiac surgery

Age before duty: the effect of storage duration on mortality after red blood cell transfusion

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