Results of the Informing Fresh versus Old Red Cell Management (INFORM) trial have recently been presented at the AABB annual meeting and published in The New England Journal of Medicine. The INFORM trial is the largest randomized, controlled trial examining whether fresh red blood cells (RBCs) are superior to older RBCs. Over 31,000 adult patients were randomized in a 1:2 ratio to receive either fresh RBCs (11 days; IQR, 8-16) or standard issue RBCs (23 days; IQR, 16-31) for transfusion. Based on patients with blood type A or O, in-hospital mortality was similar in both groups—9.1% in the fresh RBC group versus 8.7% in the standard issue group (OR, 1.05; 95% CI, 0.95-1.16; p=0.34). Results were similar for all blood types examined and all subgroups of patients including cardiovascular surgery, intensive care, and cancer patients. These results confirm that standard issue RBCs are appropriate for most hospitalized adult patients. Further research is needed to evaluate whether RBCs stored during the last week of storage (35-42 days) are associated with increased mortality.
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Very interesting finding. My concern is that the conditions studied have high mortality. I am wondering whether the patients morbidity post transfusion could be studied such as quality of life.
It would also be good to compare post-transfusion red cell survival of fresh RBCs vs standard issue RBCs. This could be important in some patients on chronic transfusion regimen such as sickle cell disease and thalassaemia.