Mortality outcomes in patients transfused with fresher versus older red blood cells: a meta‐analysis

Chai‐Adisaksopha, Chatree; Alexander, Paul; Guyatt, Gordon; Crowther, Mark; Heddle, Nancy M.; Devereaux, P.J.; Ellis, Martin; Roxby, David; Sessler, Daniel I.; Eikelboom, John W.

doi:10.1111/vox.12495

Cited by 44 publications

(33 citation statements)

References 47 publications

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“…Although there are evidences reporting the potential harm of transfusing stored RBCs [1,2,3,4,5,6,7,8,9,10,11], other studies on randomized clinical trials reported no difference in mortality of patients who received fresher versus older RBCs [23,24,25,26]. Most published clinical studies are non-randomized observational studies with methodologic limitations.…”

Section: Discussionmentioning

confidence: 99%

MicroRNA Dysregulation Associated with Red Blood Cell Storage

Chen

Xie

Xing

et al. 2018

Transfus Med Hemother

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Introduction: Stored red blood cells (RBCs) undergo storage lesions involving morphological, physiological and biochemical changes. MicroRNAs (miRNAs) have important functions in cell apoptosis and life processes. Therefore, the aim of this study was to explore potential roles of miRNAs in the damage of stored RBCs. Methods: Blood samples were collected from 13 healthy male O-type donors, and leuko-reduced RBCs were divided into fresh RBC group and 20-day storage RBC group. Results: Eight predicted miRNAs with modified expressions with an intersection ≥ 3 were found dysregulated in the 20-day storage RBC group and involved in apoptosis and senescence signaling pathway: miR-31-5p, miR-196a-5p, miR-203a, miR-654-3p and miR-769-3p were increased, while miR-96-5P, miR-150-5P and miR-197-3p were decreased. Evidence associating miR-31-5p, miR-203a, miR-654 and miR-769 to RBCs or blood in general are not available. Conclusions: Dysregulated miRNAs might represent potential biomarkers to identify storage lesions, and their detection might help to evaluate the quality of stored RBCs.

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Section: Discussionmentioning

confidence: 99%

MicroRNA Dysregulation Associated with Red Blood Cell Storage

Chen

Xie

Xing

et al. 2018

Transfus Med Hemother

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“…These results should provide adequate reassurance that storage duration has no clinical impact. Several older and smaller trials,789101112131415161718192021 as well as recent meta-analyses,222324 have reported similar conclusions. However, clinical, methodological, and statistical problems may have affected the analysis and interpretation of trial results.…”

mentioning

confidence: 69%

Can we be certain that storage duration of transfused red blood cells does not affect patient outcomes?

Trivella

Stanworth

Brunskill

et al. 2019

BMJ

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“…Large clinical trials have provided strong evidence that a prolonged storage time is not related to complications of RBC transfusions. 51,52 On the contrary, a meta-analysis suggest that fresh RBC may even be more harmful, 53 which is suggested to be related to the manufacturing method. 54 However, the manufacturing method is not likely to be the explanation for the findings in this study, as all patients received red cell filtered RBC products that were manufactured the same way.…”

Section: Discussionmentioning

confidence: 99%

Red blood cell transfusion results in adhesion of neutrophils in human endotoxemia and in critically ill patients with sepsis

et al. 2019

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BACKGROUND: Red blood cell (RBC) transfusion is associated with adverse effects, which may involve activation of the host immune response. The effect of RBC transfusion on neutrophil Reactive Oxygen Species (ROS) production and adhesion ex vivo was investigated in endotoxemic volunteers and in critically ill patients that received a RBC transfusion. We hypothesized that RBC transfusion would cause neutrophil activation, the extent of which depends on the storage time and the inflammatory status of the recipient. STUDY DESIGN AND METHODS: Volunteers wereinjected with lipopolysaccharide (LPS) and transfused with either saline, fresh, or stored autologous RBCs. In addition, 47 critically ill patients with and without sepsis receiving either fresh (<8 days) or standard stored RBC (2-35 days) were included. Neutrophils from healthy volunteers were incubated with the plasma samples from the endotoxemic volunteers and from the critically ill patients, after which priming of neutrophil ROS production and adhesion were assessed. RESULTS:In the endotoxemia model, ex vivo neutrophil adhesion, but not ROS production, was increased after transfusion, which was not affected by RBC storage duration. In the critically ill, ex vivo neutrophil ROS production was already increased prior to transfusion and was not increased following transfusion. Neutrophil adhesion was increased following transfusion, which was more notable in the septic patients than in non-septic patients. Transfusion of fresh RBCs, but not standard issued RBCs, resulted in enhanced ROS production in neutrophils.CONCLUSION: RBC transfusion was associated with increased neutrophil adhesion in a model of human endotoxemia as well as in critically ill patients with sepsis.From the

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Mortality outcomes in patients transfused with fresher versus older red blood cells: a meta‐analysis

Abstract: Transfusion of fresher red blood cells does not reduce overall or in-hospital mortality when compared with older red blood cells. Our results support the practice of transfusing patients with the oldest red blood cells available in the blood bank.

Cited by 44 publications

References 47 publications

MicroRNA Dysregulation Associated with Red Blood Cell Storage

MicroRNA Dysregulation Associated with Red Blood Cell Storage

Can we be certain that storage duration of transfused red blood cells does not affect patient outcomes?

Red blood cell transfusion results in adhesion of neutrophils in human endotoxemia and in critically ill patients with sepsis

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