Red blood cells, or RBCs, are routinely used in the transfusion of ill patients to deliver oxygen to tissues. Additive solutions, special containers, and processing procedures permit red cells to have an extended shelf-life. This allows transfusion services to maintain adequate supplies of blood products for patients with different blood types and transfusion needs. On average, RBC units are stored for two or three weeks before transfusion.
RBCs stored over time have altered deformability, and morphologic and biochemical changes which decrease oxygen-carrying capacity and may reduce red cell survival. Observational studies have suggested that among transfusion recipients, these changes may be associated with increased complications, infections, and mortality. A study published in 2008 found that among cardiac surgery patients, transfusion of RBCs stored for more than 14 days was associated with increased in-hospital morbidity and mortality. However, rigorous evidence on the effect of prolonged storage on clinical outcomes in patients has been largely unavailable.
The Age of Red Blood Cells in Premature Infants trial, also known as ARIPI , was a double-blind, randomized controlled trial conducted by researchers from six Canadian tertiary neonatal intensive care units. The trial assessed the effect of RBC storage time on morbidity and mortality among premature, low-birth-weight infants. It compared outcomes of patients receiving fresh red blood cells, which had been stored for less than 7 days, with patients receiving standard-issue units, which had been stored for an average of 14.6 days. The researchers found no significant difference in 90-day morbidity or mortality between trial arms. The results were presented at the Boston AABB meeting and published in the Journal of the American Medical Association.
Dr. Dean Fergusson was the principal investigator of the trial and noted:
“The ARIPI trial demonstrates that current transfusion management and practice does not need to be changed for blood banks servicing neonatal intensive care units. Whether the results of ARIPI are generalizable to other populations requiring transfusions remains unknown.”
A further understanding of the clinical implications of prolonged red blood cell storage is critical to establishing effective transfusion policy. Fortunately, multiple randomized trials in adults are currently underway.
We’ll be back on November 15 with another edition of Transfusion News. In the meantime, you can always keep up to date with all of the latest news by visiting transfusionnews.com. 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: 1-9.
2. Lacroix J, Hebert P, Fergusson D, Tinmouth A, Blajchman MA, Callum J, Cook D, Marshall JC, McIntyre L, Turgeon AF. The Age of Blood Evaluation (ABLE) randomized controlled trial: study design. Transfus Med Rev 2011;25: 197-205.
3. Edgren G, Kamper-Jorgensen M, Eloranta S, Rostgaard K, Custer B, Ullum H, Murphy EL, Busch MP, Reilly M, Melbye M, Hjalgrim H, Nyren O. Duration of red blood cell storage and survival of transfused patients (CME). Transfusion 2010;50: 1185-95.
4. Flegel WA. Fresh blood for transfusion: how old is too old for red blood cell units? Blood Transfus 2012;10: 247-51.
5. Koch CG, Li L, Sessler DI, Figueroa P, Hoeltge GA, Mihaljevic T, Blackstone EH. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med 2008;358: 1229-39.
6. Wang D, Sun J, Solomon SB, Klein HG, Natanson C. Transfusion of older stored blood and risk of death: a meta-analysis. Transfusion 2012;52: 1184-95.
