Although a recent meta-analysis of randomized trials has reported no difference in adverse events based on the age of the red blood cells (RBCs) transfused, the effect that age of RBCs play in oxygen delivery has not been examined.
New research published in JAMA evaluated the RBC age at time of transfusion on blood lactate levels to assess for lactic acidosis and act as a surrogate maker for oxygen delivery in 290 Ugandan children with severe anemia, many of whom had malaria or sickle cell disease. In a randomized trial, researchers transfused younger RBCs stored for a median of 8 days (interquartile range (IQR), 7-9 days) in half of the children (n=145) and compared lactate levels in children (n=145) transfused with RBCs stored for a longer duration (median, 32 days; IQR, 30-34 days). No difference was found between blood lactate levels of the two groups, nor other clinical markers, adverse events or survival. Since fresh RBCs have not been found to be superior, other factors affecting transfusions such as donor characteristics and the RBC collection and processing should be examined in future clinical trials.
References
- Dhabangi A, Ainomugisha B, Cserti-Gazdewich C, Ddungu H, Kyeyune D, Musisi E, Opoka R, Stowell CP, Dzik WH. Effect of Transfusion of Red Blood Cells With Longer vs Shorter Storage Duration on Elevated Blood Lactate Levels in Children With Severe Anemia: The TOTAL Randomized Clinical Trial. JAMA 2015: 1-10.
- Spinella PC, Acker J. Storage Duration and Other Measures of Quality of Red Blood Cells for Transfusion. JAMA 2015: 1-3.
- Alexander PE, Barty R, Fei Y, Vandvik PO, Pai M, Siemieniuk RA, Heddle NM, Blumberg N, McLeod SL, Liu J, Eikelboom JW, Guyatt GH. Transfusion of fresher versus older red blood cells in hospitalized patients: a systematic review and meta-analysis. Blood 2015.
