Printed from acutecaretesting.org
April 2008
Fresh is best
Summarized from Koch C, Li L, Sessler D, et al. Duration of red-cell storage and complications after cardiac surgery. New Eng J Med 2008; 358: 1229-39. Editorial: Adamson J. New Blood, Old Blood or no Blood. New Eng J Med 2008; 358: 1295-96.
In the USA it is permissible to store donated blood for transfusion for up to 42 days. Although this is helpful in matching supply with demand for blood products, red cells undergo a number of changes in storage that affect their function.
There is conflicting evidence to suggest that the structural and functional changes occurring in red cells during storage may result in a poorer outcome for patients transfused with ‘old’ red cells compared with those transfused with freshly donated red cells. This notion was tested in a recently published clinical trial.
The study population comprised 6002 patients who had undergone cardiac surgery at the Cleveland Clinic in Cleveland Ohio between 1998 and 2006. All required transfusion of red cells during surgery, on average two units each.
Retrospective analysis of these patient’s records revealed that 2,872 had received red cells that had been stored for < 14 days (median duration of storage 11 days) and 3,130 had received red cells that had been stored for >14 days (median duration of storage 20 days). By several measures those who received newer blood (<14 days old) fared better than those given older blood (>14 days old).
For example the in-hospital mortality rate among those given old blood (2.8 %) was nearly twice that of those given newer blood (1.7 %). Similarly 2.7 % of those given old blood developed renal failure in the post operative period compared with just 1.6 % of those given newer blood and sepsis or septicemia was a postoperative complication for 4.0 % of those given old blood compared with 2.8 % for those given newer blood.
Long-term survival was also more likely if newer red cells were given. One year mortality rate was significantly less (7.4 % vs. 11.0 %) in patients given newer blood. The authors of the study were able to conclude that “for patients undergoing cardiac surgery, transfusion of blood that had been stored for longer than 2 weeks was associated with significantly increased risk of postoperative complications as well as reduced short-term and long-term survival.”
In an accompanying editorial the author discusses the significance of these findings.
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