Current regulations allow red blood cells (RBCs) to be stored and used for up to 42 days. During this time, RBCs undergo many physiological and morphological changes. Recently, several randomized trials have not found any difference in RBC storage duration on clinical outcomes for cardiac surgery or general critical care patients. These studies, however, did not include trauma patients which often require massive blood transfusions that may render them more susceptible to the toxic effects of older blood. In order to investigate the effects of older blood in trauma patients, researchers analyzed data from the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial. This secondary analysis included 678 adult trauma patients who received a median of 9 units of packed RBCs (IQR, 5.5 to 14); 100 (14.8%) of these patients died within the first 24 hours of hospitalization. Based on multivariable analysis, each unit of RBCs stored at least 22 days or longer was associated with a 5% increase in odds of 24-hour mortality for those trauma patients who received at least 10 units of packed RBCs (adjusted odds ratio 1.05 per packed RBC unit; 95% CI, 1.01 to 1.08). Furthermore, older blood was associated with adverse events and increased 30-day mortality. Additional prospective clinical trials for trauma patients may be needed to better understand the association between RBC storage duration and clinical outcomes.
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