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

Trivella, Marialena; Stanworth, Simon; Brunskill, Susan J; Dutton, Peter; Altman, Douglas G.

doi:10.1136/bmj.l2320

Cited by 17 publications

(21 citation statements)

References 37 publications

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“…However, it has been argued that a range of clinical, methodologic, and statistical problems do affect the analysis and interpretation of trial results for RBC storage age, and indeed the levels of reassurance for clinicians may not be that strong. 26 A number of studies have identified variable associations between the storage age of PLT concentrates with laboratory variables and inflammatory adverse events. [7][8][9] In adults, a cohort study of 381 critically ill trauma patients reported that exposure to older apheresis PLT concentrates did not impact mortality or rates of acute respiratory distress syndrome or renal or liver failure, but was independently associated with higher rates of sepsis.…”

Section: Discussionmentioning

confidence: 99%

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Effect of platelet storage duration on clinical outcomes and incremental platelet change in critically ill children

et al. 2020

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Background The safety of platelet (PLT) concentrates with longer storage duration has been questioned due to biochemical and functional changes that occur during blood collection and storage. Some studies have suggested that transfusion efficacy is decreased and immune system dysfunction is worsened with increased storage age. We sought to describe the effect of PLT storage age on laboratory and clinical outcomes in critically ill children receiving PLT transfusions. Study Design and Methods: We performed a secondary analysis of a prospective, observational point-prevalence study. Children (3 days to 16 years of age) from 82 pediatric intensive care units in 16 countries were enrolled if they received a PLT transfusion during one of the predefined screening weeks. Outcomes (including PLT count increments, organ dysfunction, and transfusion reactions) were evaluated by PLT storage age. Results: Data from 497 patients were analyzed. The age of the PLT transfusions ranged from 1 to 7 days but the majority were 4 (24%) or 5 (36%) days of age. Nearly two-thirds of PLT concentrates were transfused to prevent bleeding. The indication for transfusion did not differ between storage age groups Abbreviations: IQR, interquartile range; PICU, pediatric intensive care unit. †The P 3 T investigators are listed in the acknowledgements.

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Section: Discussionmentioning

confidence: 99%

“…No such comparable randomized trials exist for PLT storage age. However, it has been argued that a range of clinical, methodologic, and statistical problems do affect the analysis and interpretation of trial results for RBC storage age, and indeed the levels of reassurance for clinicians may not be that strong 26 …”

Section: Discussionmentioning

confidence: 99%

Effect of platelet storage duration on clinical outcomes and incremental platelet change in critically ill children

et al. 2020

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“…Randomized clinical trials in the settings of critically ill adults (23), cardiac surgery (24), and adult hospitalized patients (25), in which subjects were assigned to transfusion of either short duration storage RBCs or prolonged duration stored RBCs, have not demonstrated differences in mortality or secondary outcomes such as length of stay, or transfusion reactions. The generalizability of these trials to the treatment of speci c patients has been questioned on the basis of a number of clinical and methodologic issues, including inconsistency in the de nition of short, standard, and prolonged storage; heterogeneity of case mix; multiple transfusions; and dichotomization of the continuous variable of storage duration (26). Notably, none of these trials utilized any direct measure of RBC unit quality.…”

Section: Discussionmentioning

confidence: 99%

Using Redox Potential as a Feasible Marker for Banked Blood Quality and the State of Oxidative Stress in Stored Red Blood Cells

Daniels

Jun

Davenport

et al. 2020

Preprint

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Background Stored Red Blood Cells (RBCs) may undergo oxidative stress over time, with functional changes affecting critical tasks such as oxygen delivery. Central to these changes are oxidation-reduction (redox) reactions and the redox potential (RP) that must be maintained for proper cell function. RP imbalance can lead to oxidative stress that may contribute to storage lesions and transfusion-related morbidities. Direct measures of RP may allow for evaluation of erythrocyte quality and enable corrections of RP prior to transfusion. Methods Multiple random RBC segments were tested, ranging in age from 5 to 40 days at 5 day intervals. RP was recorded by measuring open circuit potential of RBCs using novel nanoporous gold electrodes with Ag/AgCl reference. RP measures were also performed on peripheral venous blood samples from 10 healthy volunteers. RP measures were compared between groups of aged RBCs, and with volunteer blood. Results Stored RBCs show time-dependent increases in RP. There were significant differences in Day 5 RP compared to all other groups (p≤0.005), Day 10-15 vs ages ≥ Day 20 (p≤0.025), Day 20-25 vs Day 40 (p=0.039), and all groups compared to healthy volunteers. RP became more positive over time suggesting ongoing oxidation as RBCs age. However, storage time alone does not predict the ultimate RP value measured from a given unit.Conclusions There are significant differences in RP between freshly stored RBCs and all others, with RP becoming more positive over time. However, storage time alone does not predict RP, indicating RP screening may be important independent of storage time and may serve as a marker of RBC quality and state of oxidative stress. RP measurements may also provide a target by which to restore RP balance in aged pRBCs, improving their clinical effectiveness while reducing associated morbidities.

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“…However, uncertainties still remain for RBC units at the extremes of storage duration, as it is the biological changes in oldest RBCs that have been of most concern, and for certain populations that may receive multiple RBC units (e.g., massive transfusion) 99. Further RCTs are unlikely to answer this question, and individual patient data metaanalyses of the completed trials are being planned 99. Focus has also shifted towards other factors that may affect RBC quality, such as collection and processing methods.…”

mentioning

confidence: 99%

Transfusion in critical care: Past, present and future

Shah

Oczkowski

Aubron

et al. 2020

Transfusion Medicine

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Anaemia and coagulopathy are common in critically ill patients and are associated with poor outcomes, including increased risk of mortality, myocardial infarction, failure to be liberated from mechanical ventilation and poor physical recovery. Transfusion of blood and blood products remains the corner stone of anaemia and coagulopathy treatment in critical care. However, determining when the benefits of transfusion outweigh the risks of anaemia may be challenging in some critically ill patients. Therefore, the European Society of Intensive Care Medicine prioritised the development of a clinical practice guideline to address anaemia and coagulopathy in non-bleeding critically ill patients. The aims of this article are to: (1) review the evolution of transfusion practice in critical care and the direction for future developments in this important area of transfusion medicine and (2) to provide a brief synopsis of the guideline development process and recommendations in a format designed for busy clinicians and blood bank staff. These clinical practice guidelines provide recommendations to clinicians on how best to manage non-bleeding critically ill patients at the bedside. More research is needed on alternative transfusion targets, use of transfusions in special populations (e.g., acute neurological injury, acute coronary syndromes), use of anaemia prevention strategies and point-of-care interventions to guide transfusion strategies.

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

Abstract: Large pragmatic randomised trials have found no evidence that the age of red blood cells affects patient survival, but Trivella and colleagues say that problems with their design and analysis leave unanswered questions about safety

Cited by 17 publications

References 37 publications

Effect of platelet storage duration on clinical outcomes and incremental platelet change in critically ill children

Effect of platelet storage duration on clinical outcomes and incremental platelet change in critically ill children

Using Redox Potential as a Feasible Marker for Banked Blood Quality and the State of Oxidative Stress in Stored Red Blood Cells

Transfusion in critical care: Past, present and future

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