Transfusion of fresher vs older red blood cells in hospitalized patients: a systematic review and meta-analysis

Alexander, Paul; Barty, Rebecca; Fei, Yutong; Vandvik, Per Olav; Pai, Menaka; Siemieniuk, Reed; Heddle, Nancy M.; Blumberg, Neil; McLeod, Shelley; Liu, Jianping; Eikelboom, John W.; Guyatt, Gordon

doi:10.1182/blood-2015-09-670950

Cited by 102 publications

(88 citation statements)

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“…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,).…”

Section: Resultsmentioning

confidence: 99%

“…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. 15 To 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.…”

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confidence: 99%

“…9 Most studies in trauma and cardiac surgery reported that prolonged RBC storage was a risk factor for postoperative infections after cardiac surgery, [10][11][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.…”

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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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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

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

et al. 2017

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“…Similarly, RCTs also could not demonstrate adverse effects of aged RBC transfusions on mortality or organ failure compared to fresh RBC transfusions. 26,27 Although using allogeneic RBC transfusions to achieve a hemoglobin target of >9 g/dL appears to be relatively safe for most critically ill patients, this does not imply allogeneic RBCs are totally safe for all critically ill patients.…”

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Context-dependent risks and benefits of transfusion in the critically ill

Harahsheh¹,

Ho²

2017

IJCTM

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Transfusion of red blood cells (RBCs) and other blood products to critically ill patients is common. Blood products are expensive, and not without risks. Recent evidence from high-quality multicenter randomized controlled trials confirmed the safety of allogeneic RBC transfusions, including the use of aged RBCs, and mild to moderate anemia for most stable and nonbleeding critically ill patients. Emerging evidence suggests that a liberal RBC transfusion target may have potential divergent effects on patient outcomes depending on their clinical context, with possible harms for patients with gastrointestinal bleeding due to portal hypertension and, conversely, benefits for patients with severe underlying cardiovascular diseases. Despite an apparent increased risk of bleeding in critically ill patients with deranged coagulation parameters and thrombocytopenia, recent studies suggested that fresh frozen plasma (FFP) and platelet transfusions may not be beneficial and, indeed, also not very effective in correcting these abnormalities. As for patients who have active severe critical bleeding, use of empirical 1:1:1 RBC: platelets: FFP transfusion appears justifiable in an attempt to reduce deaths as a result of exsanguination. In conjunction with platelet count and fibrinogen concentration, whole blood viscoelastic and platelet function tests are particularly useful to assist clinicians to rationalize FFP and platelet transfusions, when imminent death from exsanguination is not anticipated. Because the risks and benefits of blood product transfusion are heavily context-dependent, a thorough consideration of the characteristics and clinical status of the patients, in conjunction with viscoelastic and platelet function tests, is needed to rationalize the decision to transfuse (or withhold) blood products -very much in line with the move toward the practice of individualized or personalized medicine.

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“…19,20 A recent meta -analysis and systematic review has indicated that the current evidence provides moderate certainty that use of fresher RBCs does not influence mortality, and low certainty that it does not influence adverse events but could possibly increase infection rates. 21 In addition, handling of the blood products greatly influences the quality of both the shorter-and the longer -stored RBC units. Once issued by the blood bank, the transfusion of RBC units should be commenced within 30 minutes of removal from the optimal storage conditions.…”

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confidence: 99%