Transfusions of CPDA‐1 red blood cells stored for up to 28 days decrease donor exposures in very low‐birth‐weight premature infants

Cunha, Deyse Helena Fernandes da; Santos, Amélia Miyashiro Nunes dos; Kopelman, Benjamin Israel; Areco, Kelsy Catherina Nema; Guinsburg, Ruth; Peres, C.; Chiba, Akemi Kuroda; Kuwano, Sachie T.; Terzian, Cláudia Cristina Naufel; Bordin, José Orlando

doi:10.1111/j.1365-3148.2005.00624.x

Cited by 53 publications

(77 citation statements)

References 21 publications

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“…Second, the standard-of-care arm still received relatively fresh blood -only 12 infants received red cells that were exclusively more than 14 days old. Given that the average blood storage in the US is 18 days [1], and certain centres routinely store red cells for longer than 21 days [117], these results may not be applicable to the broader population.…”

Section: Randomised Controlled Trials (Rct)mentioning

confidence: 96%

“…These have included healthy volunteers [67,[80][81][82], numerous retrospective and prospective observational studies [77,, and a handful of older [115][116][117][118][119][120][121][122][123], more recent [124], and ongoing randomised controlled trials. Overall, study results have been conflicting and affected by multiple methodological issues including confounding, systematic bias, limited external validity and multiple statistical shortcomings.…”

Section: Current State Of Clinical Evidence On the Clinical Relevancementioning

confidence: 99%

“…Although close to a dozen RCTs have been published on the relationship between storage duration and adverse outcomes [115][116][117][118][119][120][121][122][123][124], the majority have been either small or not adequately powered to evaluate mortality. Moreover, none of them have found any significant differences in outcomes between fresh and old subgroups of transfusion recipients across a variety of clinical settings.…”

Section: Randomised Controlled Trials (Rct)mentioning

confidence: 99%

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The pathophysiology and consequences of red blood cell storage

2014

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Red cell transfusion therapy is a common treatment modality in contemporary medical practice. Although blood collection and administration is safer and more efficient than ever before, red cells undergo multiple metabolic and structural changes during storage that may compromise their functionality and viability following transfusion. The clinical relevance of these changes is a hotly debated topic that continues to be a matter of intense investigation. In the current review, we begin with an in-depth overview of the pathophysiological mechanisms underlying red cell storage, with a focus on altered metabolism, oxidative stress and red cell membrane damage. We proceed to review the current state of evidence on the clinical relevance and consequences of the red cell storage lesion, while discussing the strengths and limitations of clinical studies.

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Section: Randomised Controlled Trials (Rct)mentioning

confidence: 96%

Section: Current State Of Clinical Evidence On the Clinical Relevancementioning

confidence: 99%

Section: Randomised Controlled Trials (Rct)mentioning

confidence: 99%

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The pathophysiology and consequences of red blood cell storage

2014

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“…These results should provide adequate reassurance that storage duration has no clinical impact. Several older and smaller trials,789101112131415161718192021 as well as recent meta-analyses,222324 have reported similar conclusions. However, clinical, methodological, and statistical problems may have affected the analysis and interpretation of trial results.…”

mentioning

confidence: 70%

“…Most trials have imposed thresholds for one or both groups 34. Some trials compared transfusion of cells stored for shorter and longer durations7891011121314 while others compared shorter duration with standard (blood banking) practice 1015161718192021. Half the trials included cells stored for less than seven days,89121314151617192126 even though in practice the average storage age for transfusion is 15 days .…”

Section: Definition Of the Interventionmentioning

confidence: 99%

Can we be certain that storage duration of transfused red blood cells does not affect patient outcomes?

Trivella

Stanworth

Brunskill

et al. 2019

BMJ

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Clinical Practice Guidelines From the AABB

Carson

Guyatt

Heddle

et al. 2016

JAMA

932

284

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IMPORTANCE More than 100 million units of blood are collected worldwide each year, yet the indication for red blood cell (RBC) transfusion and the optimal length of RBC storage prior to transfusion are uncertain.OBJECTIVE To provide recommendations for the target hemoglobin level for RBC transfusion among hospitalized adult patients who are hemodynamically stable and the length of time RBCs should be stored prior to transfusion.EVIDENCE REVIEW Reference librarians conducted a literature search for randomized clinical trials (RCTs) evaluating hemoglobin thresholds for RBC transfusion (1950( -May 2016 and RBC storage duration (1948( -May 2016 without language restrictions. The results were summarized using the Grading of Recommendations Assessment, Development and Evaluation method. For RBC transfusion thresholds, 31 RCTs included 12 587 participants and compared restrictive thresholds (transfusion not indicated until the hemoglobin level is 7-8 g/dL) with liberal thresholds (transfusion not indicated until the hemoglobin level is 9-10 g/dL). The summary estimates across trials demonstrated that restrictive RBC transfusion thresholds were not associated with higher rates of adverse clinical outcomes, including 30-day mortality, myocardial infarction, cerebrovascular accident, rebleeding, pneumonia, or thromboembolism. For RBC storage duration, 13 RCTs included 5515 participants randomly allocated to receive fresher blood or standard-issue blood. These RCTs demonstrated that fresher blood did not improve clinical outcomes.FINDINGS It is good practice to consider the hemoglobin level, the overall clinical context, patient preferences, and alternative therapies when making transfusion decisions regarding an individual patient. Recommendation 1: a restrictive RBC transfusion threshold in which the transfusion is not indicated until the hemoglobin level is 7 g/dL is recommended for hospitalized adult patients who are hemodynamically stable, including critically ill patients, rather than when the hemoglobin level is 10 g/dL (strong recommendation, moderate quality evidence). A restrictive RBC transfusion threshold of 8 g/dL is recommended for patients undergoing orthopedic surgery, cardiac surgery, and those with preexisting cardiovascular disease (strong recommendation, moderate quality evidence). The restrictive transfusion threshold of 7 g/dL is likely comparable with 8 g/dL, but RCT evidence is not available for all patient categories. These recommendations do not apply to patients with acute coronary syndrome, severe thrombocytopenia (patients treated for hematological or oncological reasons who are at risk of bleeding), and chronic transfusion-dependent anemia (not recommended due to insufficient evidence). Recommendation 2: patients, including neonates, should receive RBC units selected at any point within their licensed dating period (standard issue) rather than limiting patients to transfusion of only fresh (storage length: <10 days) RBC units (strong recommendation, moderate quality evidence). CONCLUSIONS AND R...

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Transfusions of CPDA‐1 red blood cells stored for up to 28 days decrease donor exposures in very low‐birth‐weight premature infants

Cited by 53 publications

References 21 publications

The pathophysiology and consequences of red blood cell storage

The pathophysiology and consequences of red blood cell storage

Can we be certain that storage duration of transfused red blood cells does not affect patient outcomes?

Clinical Practice Guidelines From the AABB

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