Age of Transfused Blood Is Not Associated With Increased Postoperative Adverse Outcome After Cardiac Surgery

Transfusion of recently donated (fresh) red blood cells (RBCs) does not improve survival in comparison with current practice, while safety of the oldest stored units is yet to be established: a meta‐analysis

“…We next examined whether the different study designs employed and data sets obtained were associated with any divergence in the storage age of transfused RBCs. Among observational studies and RCTs reporting the median or mean storage age for the two transfused groups, we found that, although the degree of the differences in the storage age of transfused RBCs between the old and fresh RBC groups was similar for observational studies and RCTs ( P = 0·69 for interaction), there was an overall significant downward shift of the median/mean storage age of transfused RBCs from the observational studies to the RCTs (main effect, P = 0·01) (Fig. ).…”

“…Tables , summarize the characteristics of the included studies. Two RCTs and thirteen observational studies published between 2011 and 2015 were added to the 21 studies (18 observational studies and 3 RCTs) included in our previous analysis (Fig. , Tables , ) .…”

“…In the observational studies, a baseline difference in severity of illness of patients could underlie the ‘harmful’ effect of older RBCs. In 8 of 31 observational studies, the baseline severity of illness of patients in both study arms was described using a variety of scoring systems (Supplemental Figure 1) . In these studies with different severity of illness score balances between older and fresher RBC transfusion, there was no significant difference in treatment effect ( P = 0·66 for interaction) and overall, among these eight studies, older RBC transfusion significantly increased the risk of death (OR = 1·46, 95% CI = 1·00–2·14, P = 0·05).…”

Red blood cell storage duration and long‐term mortality in patients undergoing cardiac intervention: a Danish register study

“…Some studies have reported an association between RBC storage duration and increased nosocomial infections (Cholette et al ., ), Multiple Organ Dysfunction Score (Gauvin et al ., ), post‐operative wound complications (Min et al ., ) and mortality (Koch et al ., ; Eikelboom et al ., ; Robinson et al ., ; Wang et al ., ; Bordbar et al ., ). However, other studies have not shown any association between RBC storage duration and adverse clinical outcome (McKenny et al ., ; Patterson et al ., ), Multiple Organ Dysfunction Score (Steiner et al ., ) and mortality (Saager et al ., ; Aubron et al ., ; Heddle et al ., ; Lacroix et al ., ; Heddle et al ., ). A recent Cochrane Database review did not report any adverse outcome when subjects were treated with ‘older’ RBCs as compared to ‘fresher’ RBC transfusion (Brunskill et al ., ); this conclusion was also confirmed by a recent meta‐analysis (Chai‐Adisaksopha et al ., ).…”

Evaluation of an experimental filter designed for improving the quality of red blood cells (RBCs) during storage by simultaneously removing white blood cells and immunomodulators and improving RBC viscoelasticity and Band 3 proteins

“…The observed association by the authors may be influenced by several confounding factors. Nevertheless, several other observational studies including the recent study on Age of Red Blood Cells in Premature Infants (ARIPI) did not find such an association between age of RBCs and clinical outcomes 9‐11. Because the results of several systematic literature reviews and meta‐analyses of available data on the association between RBC storage and clinical outcomes are inconclusive, several randomized and controlled studies have been initiated to answer this very important question.…”