Today we’ll be discussing the age of red blood cells and the impact on clinical outcomes in cardiac surgery patients. These data were presented at the AABB annual meeting plenary session. Over time, red bloods cells undergo morphological and biochemical changes that may decrease their oxygen-carrying capacity. However, it is unclear whether these changes actually affect patient outcomes.
Dr. Triulzi from the University of Pittsburgh comments:
“There has been a large body of observational studies that have been published looking at the effects of red cell storage on clinical outcomes in various patient groups including cardiac surgery, trauma, ICU patients and pediatric patients. The results of these studies are mixed with some studies showing that longer stored blood was associated with worse outcomes and other studies not showing any difference.”
The results of randomized trials should help to answer this question. The ARIPI trial of premature infants, found no difference in patient outcomes for those receiving fresh red blood cells compared to those receiving standard of care.
New data from the NHLBI-supported Red Cell Storage Duration Study, also known as RECESS, are now available. This randomized controlled trial, conducted at 33 medical centers in the United States over four years, evaluated the effect of red blood cell storage time in transfused cardiac surgery patients. Patients were randomized to receive either leukoreduced red blood cells stored for 10 days or less or red cells stored for 21 days or more. The primary outcome was the change in the multi-organ dysfunction score through day 7 and secondary end points including changes in multi-organ dysfunction score through day 28, serious adverse events and mortality at 28 days post surgery.
Dr. Triulzi summarizes the implications of the RECESS trial:
“This is the first randomized clinical trial looking at the storage age of blood in patients undergoing complex cardiac surgery procedures, and we can say with confidence that we did not see differences in changes in multiorgan dysfunction scores, serious adverse events or mortality at day 28 in patients who were transfused with leukoreduced red blood cells that were stored for longer or shorter periods. There are other ongoing clinical trials in other patient groups such as ICU patients that will answer this question in those patient populations.”
We’ll be back with another edition of Transfusion News on November 15th. Thanks for joining us.
References
1. Fergusson DA, Hebert P, Hogan DL, LeBel L, Rouvinez-Bouali N, Smyth JA, Sankaran K, Tinmouth A, Blajchman MA, Kovacs L, Lachance C, Lee S, Walker CR, Hutton B, Ducharme R, Balchin K, Ramsay T, Ford JC, Kakadekar A, Ramesh K, Shapiro S. Effect of fresh red blood cell transfusions on clinical outcomes in premature, very low-birth-weight infants: the ARIPI randomized trial. JAMA 2012;308: 1443-51.
2. Steiner ME, Assmann SF, Levy JH, Marshall J, Pulkrabek S, Sloan SR, Triulzi D, Stowell CP. Addressing the question of the effect of RBC storage on clinical outcomes: the Red Cell Storage Duration Study (RECESS) (Section 7). Transfus Apher Sci 2010;43: 107-16.
3. Steiner ME, Triulzi D, Assmann SF, Sloan SR, Delaney M, Blajchman MA, Granger S, D’Andrea PA, Pulkrabek S, Stowell CP. Randomized Trial Results: Red Cell Storage Age is Not Associated with a Significant Difference in Multiple-Organ Dysfunction Score or Mortality in Transfused Cardiac Surgery Patients. Transfusion 2014;54 Supplement: 15A.
