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Literature Scan
New and noteworthy research from the
medical literature landscape
New Blood or Old: Do Storage Times of Red Cells
Affect Patient Outcomes?
Red blood cells (RBCs) undergo
numerous changes as they are
stored – some of which may impair
their ability to increase oxygen
delivery, which theoretically could
affect clinical outcomes in patients
needing transfusions. While earlier
observational studies have suggested that the age of stored blood
increases mortality risk in these
patients, two new studies published
in The New England Journal of
Medicine report that transfusion of
“newer” red cells – those stored for
a shorter period of time – was not
associated with better outcomes
than transfusion of “older” blood.
While the two randomized
clinical trials were conducted in
two distinct patient populations,
the findings were consistent. The
first study, known as the Red-Cell
Storage Duration Study (RECESS),
examined patients 12 years or older
who were undergoing complex
cardiac surgery and were likely to
need an RBC transfusion
The second study, the Age of
Blood Evaluation (ABLE) pilot trial,
looked at the impact prolonged
storage of RBCs had on critically
ill adult patients in tertiary care
intensive care units who needed a
transfusion.
“ here are no
T
advantages to
patients when
the moredifficult-toprocure
fresher blood
is provided.”
—PAUL M. NESS, MD
44
ASH Clinical News
Neither study found any significant differences in the measured
patient outcomes between fresh
blood and blood that had been
stored for a longer duration.
“The RECESS study suggests
that there are no advantages to patients when the more-difficult-toprocure fresher blood is provided,
compared with the use of standard
blood,” Paul M. Ness, MD, an
investigator on the RECESS study
and professor of pathology at Johns
Hopkins University Hospital, told
ASH Clinical News. “The current
standard of care usually provides
blood that has been stored for
around three weeks.”
In the United States, storage
systems are allowed to store blood
for up to 42 days, with most facilities adopting a “first in, first out”
inventory management approach to
minimize waste of blood components. Fresh blood is even more
difficult to procure in larger transfusion centers: Suppliers typically
send fresh blood to smaller or more
remote centers first, and unused
blood is sent back for redistribution to larger centers, increasing
the likelihood that patients at these
larger facilities will receive blood
that has been stored for a longer
time period.
The findings from these latest
clinical trials seem to suggest this
current practice is sound, both for
preserving blood supply and providing good patient outcomes.
The RECESS trial included
1,481 cardiac surgery patients from
33 hospitals in the United States.
Patients were randomly assigned to
receive either red blood cell units
stored for ≤10 days (n=538) or
units stored for ≥21 days for all of
their intraoperative and postoperative transfusions.
Investigators then measured the
change in each patient’s Multiple
Organ Dysfunction Score (MODS)
and compared the scores from
before surgery with scores taken
seven days after surgery (or until
the patient’s time of death or discharge, whichever came first).
Mean change in MODS score
at seven days (the study’s primary
outcome) was 8.5±3.6 points in
the short-term storage group and
8.7±4.0 points in the longer-term
storage group (p=0.44). Even after
comparing the change in MODS
for only post-operative scores, they
found no significant differences
between the two groups
There were also no significant
differences between the groups for
all-cause mortality, 28-day change
in MODS, length of hospital stay, or
length of ICU stay.
In the ABLE trial, investigators,
led by Jacques Lacroix, MD, from
Centre Hospitalier Universitaire
Sainte-Justine in Montreal, assigned
critically ill adults from 64 centers
in Canada and Europe to receive
either red blood cells stored for <8
days (n=1,206) or standard-issue
red blood cells (n=1,206). Red
blood cells were stored a median
of 6.1±4.9 days in the fresh-blood
group, and 22.0±8.4 days in the
standard-blood group.
At 90 days, rates of all-cause
mortality (the study’s primary
endpoint) was 37 percent in the
fresh-blood group and 35.3 percent
in the standard-blood group (absolute risk difference = 1.7 percentage
points; 95% CI –2.1 to 5.5).
In the survival analysis, Dr.
Lacroix and investigators found
no significant differences between
the two groups (hazard ratio = 1.1;
95% CI 0.9-1.2; p=0.38). They also
noted no significant between-group
differences in secondary outcomes,
such as major illness, length of
hospital stay, transfusion reactions,
or duration of respiratory, hemodynamic, or renal support.
While both studies affirm current practices, Dr. Ness said it’s still
unclear whether blood that is closer
to its expiration date of 42 days
could affect clinical outcomes. Animal studies at the National Institutes
of Health have suggested that very
o