A randomized trial published in the journal Blood utilized a dog model to show that transfusion of 42-day old blood was associated with increased mortality, as compared to receiving 7-day old blood.
In an accompanying editorial, Dr. Jeffrey McCullough commented on the study. Here is Dr. McCullough:
“The animals receiving longer stored red cells had decreased survival, greater degree of shock, higher pulmonary artery pressure and other adverse effects. However there are some specifics related to this blood loss and replacement model that may not apply to the human situation, so the study provides a nice model for future studies.”
In the United States, red cells are licensed for storage up to 42 days, although lengthy storage is known to induce the storage lesion. Some studies have suggested that transfusing blood older than 14 to 21 days may increase the risk of morbidity and mortality.
A study led by Dr. Steven Frank examined erythrocyte deformability, one component of the storage lesion.
Here is Dr. Frank:
“The primary finding in our study is that red blood cells stored for longer than 3 weeks duration, had a stiffened, less flexible cell membrane, and that these changes were not reversible after the cells were transfused back into the circulation. So unlike some of the other adverse effects of red blood cell storage, this type of damage to the cells appears to be permanent.”
However, a separate study including nearly 7,000 noncardiac surgical patients led to different conclusions. Published in the journal Anesthesiology, this retrospective analysis found that longer storage of erythrocytes was not associated with increased mortality.
Again, here is Dr. McCullough:
“Potential adverse effects of longer stored red cells is one of the most important current issues in transfusion medicine. Some studies have suggested that long stored red cells might have detrimental effects especially in patients undergoing cardiovascular surgery. Other studies have not confirmed this however. Now a large clinical trial is underway, but even that may not provide final unequivocal answers because the complexity of these kinds of trials is pretty substantial.”
We’ll be back on May 15th with another edition of Transfusion News. Thanks for joining us.
1. Solomon SB, Wang D, Sun J, Kanias T, Feng J, Helms CC, Solomon MA, Alimchandani M, Quezado M, Gladwin MT, Kim-Shapiro DB, Klein HG, Natanson C. Mortality increases after massive exchange transfusion with older stored blood in canines with experimental pneumonia. Blood 2013;121: 1663-72.
2. Saager L, Turan A, Dalton JE, Figueroa PI, Sessler DI, Kurz A. Erythrocyte storage duration is not associated with increased mortality in noncardiac surgical patients: a retrospective analysis of 6,994 patients. Anesthesiology 2013;118: 51-8.
4. Frank SM, Abazyan B, Ono M, Hogue CW, Cohen DB, Berkowitz DE, Ness PM, Barodka VM. Decreased Erythrocyte Deformability After Transfusion and the Effects of Erythrocyte Storage Duration. Anesth Analg 2013;116:975-981.