Red blood cells (RBCs) may be stored for up to 42 days before transfusion; however, over time they may develop biochemical, metabolic, and morphological changes, collectively referred to as storage lesions. Randomized clinical trials (RCTs) have shown non-inferiority between RBCs stored for standard durations compared to fresher cells. Certain patient populations, such as those with sickle cell disease (SCD), however, may be more sensitive to RBCs that have developed storage lesions. In a prospective, blinded trial, researchers randomized adult patients with SCD who were receiving chronic outpatient RBC transfusions every 3-8 weeks to receive either younger RBCs stored <10 days (n=13) or older cells stored >30 days (n=11) for three consecutive transfusions. Pre-transfusions blood samples, as well as post-transfusion blood samples, were collected and analyzed immediately following transfusion and at 2- and 24-hours post-transfusion. After transfusion, both RBC and plasma metabolic and hematologic profiles were distinct for cells stored <10 days compared to >30 days prior to transfusion. A regulator of oxygen unloading, 2,3-bisphosphoglycerate was higher in recipients who received RBCs stored for a shorter duration compared to recipients who received older cells. In addition, anti-inflammatory cytokines and hemoglobin were higher in recipients who received RBCs stored <10 days while recipients of older cells had higher levels of free iron, and pro-inflammatory cytokines. Further analysis of data from this RCT will focus on the clinical outcomes in the two arms of the study, including adverse events and hospitalization rates to help determine if some patient subpopulations may benefit from RBCs stored for a shorter duration.
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