Does the storage time of transfused red blood cells influence regional or global indexes of tissue oxygenation in anemic critically ill patients?*

Walsh, Timothy; McArdle, Fiona; McLellan, Stuart; Maciver, Caroline R.; Maginnis, Michael; Prescott, R. J.; McClelland, D. B. L.

doi:10.1097/01.ccm.0000108878.23703.e0

Cited by 232 publications

(160 citation statements)

References 28 publications

Supporting

Mentioning

145

Contrasting

Unclassified

Order By: Relevance

“…The outcome of (some of) these studies are probably confounded by a lack of transfusion policy and the use of leukocyte-non-depleted RBC preparations. Our observations on lack of correlation between change in oxygenation, duration of MV or PICU stay and length of RBC storage are compatible with experimental and clinical data indicating no difference in regional or global indexes of tissue oxygenation, or patient outcome in critically ill adults with organ failure [4][5][6].…”

supporting

confidence: 72%

Length of storage of red blood cells does not affect outcome in critically ill children

et al. 2008

View full text Add to dashboard Cite

Sir: Length of red blood cell (RBC) storage has been proposed a contributing factor to adverse outcome after RBC transfusion. This may be explained by an impaired ability to transport or deliver oxygen, or the presence of leukocytes in stored RBC preparations producing potential deleterious pro-inflammatory mediators or bioactive lipids [1]. We hypothesized that length of RBC storage might explain our previously observed independent association between RBC transfusion and increased mortality, duration of mechanical ventilation (MV) and length of paediatric intensive care unit (PICU) stay in critically ill children [2].For each time a patient was transfused in our previous study, length of RBC storage was retrieved from our hospital's blood bank [2]. Since we observed a dose-outcome relation between the number of RBC transfusions and mortality, we separately looked at single transfusion and multiple transfusions. The effect of RBC transfusion on oxygenation was assessed by the oxygenation index (OI, mean airway pressure times FiO 2 divided by PaO 2 ) and PaO 2 /FiO 2 ratio. RBC preparations were leukocyte-depleted, but not irradiated. Statistical analysis was performed using the Student t-test; linear regression analysis was applied to study correlations. P \ 0.05 was accepted as statistically significant.Data of 295 patients were studied, of whom 67 (22.7%) were transfused; 39 (58.2%) were transfused only once, the remaining 28 received multiple transfusions at different time intervals (range 2-14) (Table 1). Seventeen (5.8%) patients died. The mean length of RBC storage was 16.7 ± 0.6 days [25-75% interquartile range (IQR) 9-23 days]. Length of RBC storage was comparable between survivors and non-survivors. This remained after comparing single versus multiple transfusions. Differences in OI and PaO 2 /FiO 2 ratio between the first day and fifth day after transfusion, duration of MV and length of PICU stay were not correlated with length of RBC storage.Our findings indicate that our previous reported observed independent association between transfusion of leucocyte-depleted RBC preparations and increased morbidity in critically ill children could not be explained by length of RBC storage. Mortality was also not influenced by length of RBC storage, although our study might not be powered to detect this. To our knowledge, although the issue of RBC transfusion has been extensively studied in critically ill adults, no other paediatric data on length of RBC storage and outcome in critically ill children have been reported. Results from retrospective and prospective Mean length of RBC storage (days ± SEM) 14.7 ± 1.4 13.5 ± 3.0 15.8 ± 1.5 16.0 ± 3.5 DOI difference in oxygenation index, DPaO 2 /FiO 2 difference in PaO 2 /FiO 2 ratio, RBC red blood cell, SEM standard error of the mean Intensive

show abstract

supporting

confidence: 72%

Length of storage of red blood cells does not affect outcome in critically ill children

et al. 2008

View full text Add to dashboard Cite

show abstract

“…Because of the importance of the original Marik and Sibbold study in the debate over the quality of stored red blood Patients receiving older blood had longer ICU stay but did not have a higher need for ICU care [51] Randomized trial of RBC < 10 or > 10 days in surgical and critically ill patients This largest well-conducted retrospective review found no association [53] Review of registry of all repeat midline sternotomy patients for CABG, valve, or both 321 Age of RBCs, associated in a regression model with in-hospital and out-of-hospital mortality Age of red blood cells, associated in a regression model with in-hospital and out-of-hospital mortality cells, Walsh and his colleagues at the Edinburgh Royal Infirmary reported a randomized, prospective double blind trial in 2004 [48]. Twelve patient volunteers in septic shock were randomized to receive transfusions with red blood cells stored for greater than 20 days, and 10 more were given red blood cells stored for less than 5 days.…”

Section: Data From Clinical Studiesmentioning

confidence: 99%

Current issues relating to the transfusion of stored red blood cells

Zimrin¹,

2009

View full text Add to dashboard Cite

The development of blood storage systems allowed donation and transfusion to be separated in time and space. This separation has permitted the regionalization of donor services with subsequent economies of scale and improvements in the quality and availability of blood products. However, the availability of storage raises the question of how long blood products can and should be stored and how long they are safe and effective. The efficacy of red blood cells was originally measured as the increment in haematocrit and safety began with typing and the effort to reduce the risk of bacterial contamination. Appreciation of a growing list of storage lesions of red blood cells has developed with our increasing understanding of red blood cell physiology and our experience with red blood cell transfusion. However, other than frank haemolysis, rare episodes of bacterial contamination and overgrowth, the reduction of oxygen-carrying capacity associated with the failure of some transfused cells to circulate, and the toxicity of lysophospholipids released from membrane breakdown, storage-induced lesions have not had obvious correlations with safety or efficacy. The safety of red blood cell storage has also been approached in retrospective epidemiologic studies of transfused patients, but the results are frequently biased by the fact that sicker patients are transfused more often and blood banks do not issue blood products in a random order. Several large prospective studies of the safety of stored red blood cells are planned.

show abstract

“…In a double-blind randomised trial, Walsh et al 9 evaluated changes in gastric perfusion and oxygenation in 22 mechanically ventilated, critically ill patients who required a RBC transfusion in the absence of haemorrhage. The authors were not able to detect any adverse effects of older leuco-reduced RBCs (all units stored for > 20 days) on gastric intramucosal pH or arterial-gastric mucosal carbon dioxide gap when compared with fresh RBC transfusions (all units stored for < 5 days) or with baseline pre-transfusion values.…”

Section: Randomised Controlled Trialsmentioning

confidence: 99%

The Age of BLood Evaluation (ABLE) randomised controlled trial: description of the UK-funded arm of the international trial, the UK cost–utility analysis and secondary analyses exploring factors associated with health-related quality of life and health-care costs during the 12-month follow-up

Walsh

Stanworth

Boyd

et al. 2017

Health Technol Assess

View full text Add to dashboard Cite

on behalf of the UK ABLE trial investigatorsThe Age of BLood Evaluation (ABLE) randomised controlled trial: description of the UK-funded arm of the international trial, the UK cost-utility analysis and secondary analyses exploring factors associated with health-related quality of life and health-care costs during the 12-month follow-up The full HTA archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hta. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Technology Assessment journalReports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hta This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 09/144/51. The contractual start date was in September 2011. The draft report began editorial review in September 2016 and was accepted for publication in April 2017. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the int...

show abstract

Does the storage time of transfused red blood cells influence regional or global indexes of tissue oxygenation in anemic critically ill patients?*

Abstract: Transfusion of stored leukodepleted red cells to euvolemic, anemic, critically ill patients has no clinically significant adverse effects on gastric tonometry or global indexes of tissue oxygenation. These findings do not support the use of fresh red cells in critically ill patients.

Cited by 232 publications

References 28 publications

Length of storage of red blood cells does not affect outcome in critically ill children

Length of storage of red blood cells does not affect outcome in critically ill children

Current issues relating to the transfusion of stored red blood cells

The Age of BLood Evaluation (ABLE) randomised controlled trial: description of the UK-funded arm of the international trial, the UK cost–utility analysis and secondary analyses exploring factors associated with health-related quality of life and health-care costs during the 12-month follow-up

Contact Info

Product

Resources

About