Age of Transfused Blood in Critically Ill Adults Assessed

Current regulations permit the storage of red cells for up to 42 days, but prolonged storage has been associated with changes that may render red cells ineffective as oxygen carriers and that lead to the accumulation of substances that have untoward biologic effects.

An international team of scientists led by those at Sainte-Justine University Hospital (Montreal, QC, Canada) enrolled critically ill adults from tertiary care intensive care units (ICUs) at 64 centers; 26 in Canada, 20 in the United Kingdom, 10 in France, 7 in the Netherlands, and 1 in Belgium. Between March 2009 and May 2014, at the various centers, 1,211 patients were assigned to receive fresh red cells (fresh-blood group) and 1,219 patients were assigned to receive standard-issue red cells.

Red cells were stored a mean (± standard deviation) of 6.1 ± 4.9 days in the fresh-blood group as compared with 22.0 ± 8.4 days in the standard-blood group. At 90 days, 448 patients (37.0%) in the fresh-blood group and 430 patients (35.3%) in the standard-blood group had died. There were no significant between-group differences in any of the secondary outcomes such as major illnesses; duration of respiratory, hemodynamic, or renal support; length of stay in the hospital; and transfusion reactions or in the subgroup analyses.

The authors concluded that transfusion of fresh red cells, as compared with standard-issue red cells, did not decrease the 90-day mortality among critically ill adults. Blood transfusions save lives, but there is no need to worry about the safety of the age of blood routinely used in hospitals. Alan Tinmouth, MD, a physician and scientist and a coauthor of the study said, “Previous observational and laboratory studies have suggested that fresh blood may be better because of the breakdown of red blood cells and accumulation of toxins during storage. But this definitive clinical trial clearly shows that these changes do not affect the quality of blood.” The study was published on March 17, 2015, in the New England Journal of Medicine (NEJM).

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