Association between length of storage of red blood cell units and outcome of critically ill children: a prospective observational study

Abstract

IntroductionTransfusion is a common treatment in pediatric intensive care units (PICUs). Studies in adults suggest that prolonged storage of red blood cell units is associated with worse clinical outcome. No prospective study has been conducted in children. Our objectives were to assess the clinical impact of the length of storage of red blood cell units on clinical outcome of critically ill children.MethodsProspective, observational study conducted in 30 North American centers, in consecutive patients aged <18 years with a stay ≥ 48 hours in a PICU. The primary outcome measure was the incidence of multiple organ dysfunction syndrome after transfusion. The secondary outcomes were 28-day mortality and PICU length of stay. Odds ratios were adjusted for gender, age, number of organ dysfunctions at admission, total number of transfusions, and total dose of transfusion, using a multiple logistic regression model.ResultsThe median length of storage was 14 days in 296 patients with documented length of storage. For patients receiving blood stored ≥ 14 days, the adjusted odds ratio for an increased incidence of multiple organ dysfunction syndrome was 1.87 (95% CI 1.04;3.27, P = 0.03). There was also a significant difference in the total PICU length of stay (adjusted median difference +3.7 days, P < 0.001) and no significant change in mortality.ConclusionsIn critically ill children, transfusion of red blood cell units stored for ≥ 14 days is independently associated with an increased occurrence of multiple organ dysfunction syndrome and prolonged PICU stay.

Storage of Red Blood Cells and Transfusion-Related Acute Lung Injury

“…Most clinical studies of TRALI have been conducted in operating rooms and ICU, in the form of prospective and retrospective case-control data analyses in critically ill patients in many different settings (Table 2) [3][4][5][17][18][19]21,23,25,26]. Koch et al [27] have primarily examined the effects of transfusion on cardiac patients, observing significant increase in respiratory insufficiency and necessity for mechanical ventilation after transfusion of older RBC units [3,27].…”

“…In trauma patients, the risk for development of ARDS was significantly increased in patients who received transfusion of leukoreduced RBCs stored for longer than 14 days, and transfusion of red cells older that 28 days has also been associated with deep vein thrombosis and multiple organ [19,25]. Patients who received blood units stored for longer than 14 days there was a significantly greater incidence of multiple organ dysfunction syndrome (MODS), with respiratory dysfunction observed in 10% of the cases [26]. In a retrospective observational study, post-transfusion ALI/ARDS has been assessed in critically ill patients with sepsis.…”

RBC Transfusions in Children Requiring Intensive Care Admission After Traumatic Injury*

“…Currently, no study has specifically examined the effects of storage age in pediatric trauma patients, although studies indicate that blood transfusions in this patient population are associated with increased coagulability (12). Studies now indicate that certain subgroups may benefit from fresher blood, but more evidence is required before such a recommendation can be made (13,14).…”

Fresh Red Blood Cell Transfusion and Short-Term Pulmonary, Immunologic, and Coagulation Status

“…The various changes that occur within both the RBC and storage media during ex vivo preservation have been collectively termed the RBC "storage lesion." Importantly, alterations that occur during the RBC storage process are believed potentially responsible for many of the adverse effects associated with blood product administration (2). Among these concerns is a potentially increased risk of transfusion-related acute lung injury (TRALI) (3)(4)(5)(6) as well as risk-adjusted mortality (7)(8)(9)(10).…”