One of the major controversies in transfusion medicine has been whether red blood cell (RBC) storage lesions result in increased morbidity and mortality for transfusion recipients. Several randomized trials have evaluated this issue, but none had assessed RBCs stored for more than 35 days. A secondary analysis of the INFORM trial by Cook and colleagues assessed whether transfusion of RBCs after 35-42 days of storage was associated with worse outcomes than transfusion with RBCs that had been stored for less than a week. In a multivariable model adjusting for demographics, diagnosis and blood product utilization, transfusion of RBCs stored more than 35 days was not associated with increased mortality compared to individuals who were exclusively transfused RBCs stored less than 7 days (HR=0.91; 95% confidence interval = 0.72-1.14, p=0.40). These findings reaffirm AABB’s RBC transfusion guidelines that state, “patients should receive RBC units selected at any point within their licensed dating period rather than limiting patients to transfusion of only fresh RBC units.”
Thanks for this information. It is a common practice by clinicians in my country (Cameroon, Central Africa) to insist on red cell concentrates with a shelf life of not more than 5 days. I would be pleased to share this article during the next Hemovigilance committee meeting.
We must be careful. If the test was conducted in controlled environment where subject RBC units were kept in the fridge that is under strict temperature control, the test may not be reflecting the reality. Fridge doors are opened many times during 35 days and some of the RBC units are taken out from fridge several times for compatibility test. In addition, you also have to take it in your consideration the temperature controlling practice at blood collection site, production site, blood bank, and the transportation between them. The “35 days rule” only applies when it is accompanied with strict temperature management rules and tools in the whole supply chain. In other words, 5-day shelf life could be scientifically more realistic decision based on the reality of blood handling depending on the environment you are in.