Effects of Age of Transfused Blood on Length of Stay in Trauma Patients: A Preliminary Report

Keller, Marjorie J.; Jean, Raymond; LaMorte, Wayne W.; Millham, Frederick H.; Hirsch, Erwin F.

doi:10.1097/00005373-200211000-00037

Cited by 84 publications

(85 citation statements)

References 3 publications

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“…These alterations, together with other biological substances present in preserved red blood cell units, may reduce oxygen delivery and stimulate inflammatory pathways. Observational studies in trauma patients [51][52][53] support these physiologic data by suggesting adverse clinical outcomes from the use of older rather than fresher red blood cell units, and a large randomized trial investigating the effect of red blood cell unit storage time on clinical outcomes in critically ill patients is ongoing (ISRCTN44878718; details available at www.controlledtrials.com). In our study, we did not collect data on pretransfusion storage time of red blood cell units.…”

Section: Discussionmentioning

confidence: 97%

Early massive transfusion in trauma patients: Canadian single-centre retrospective cohort study

Mahambrey

Fowler

Pinto

et al. 2009

Can J Anesth/J Can Anesth

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Purpose To determine associations between red blood cell (RBC) transfusion and early and late clinical outcomes in massively transfused adult trauma patients. Methods A retrospective cohort study (1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001) including 260 patients receiving C10 RBC units B24 hr after admission to a university-affiliated trauma centre. We extracted demographic and clinical data and used multivariable regression to determine independent effects of RBC transfusion on clinical outcomes. ]).Conclusions Hospital mortality is high among massively transfused trauma patients. Among early survivors, 48-hr RBC transfusion volume is associated with increased organ dysfunction, but not hospital mortality. Also, it is not associated with 48-hr mortality. Future research should continue to explore methods to improve hemostasis and minimize the need for RBC transfusion. RésuméObjectif De´terminer les associations qui existent entre la transfusion d'e´rythrocytes et les devenirs cliniques R. A. Fowler and N. K. J. Adhikari contributed equally to this study.

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Section: Discussionmentioning

confidence: 97%

Early massive transfusion in trauma patients: Canadian single-centre retrospective cohort study

Mahambrey

Fowler

Pinto

et al. 2009

Can J Anesth/J Can Anesth

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“…Regarding the effect of storage duration on transfusion-related pulmonary complications, Vamvakas and Carven found no association between storage age and the probability of intubation or the duration of mechanical ventilation in patients receiving blood transfusion for coronary artery bypass surgery (45). Numerous other investigators have also failed to associate duration of RBC storage with adverse respiratory outcomes (46)(47)(48)(49).…”

Section: Discussionmentioning

confidence: 99%

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

Kor¹,

Kashyap²,

Weiskopf

et al. 2012

Am J Respir Crit Care Med

102

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Rationale: Transfusion-related pulmonary complications are leading causes of morbidity and mortality attributed to transfusion. Observational studies suggest an important role for red blood cell (RBC) storage duration in these adverse outcomes. Objectives: To evaluate the impact of RBC storage duration on shortterm pulmonary function as well as immunologic and coagulation status in mechanically ventilated patients receiving RBC transfusion. Methods: This is a double-blind, randomized, clinical trial comparing fresh (<5 d of storage) versus standard issue single-unit RBC transfusion in adult intubated and mechanically ventilated patients. The primary outcome is the change in pulmonary gas exchange as assessed by the partial pressure of arterial oxygen to fraction of inspired oxygen concentration ratio ( Since the first successful attempt at blood storage almost a century ago, advances in extracorporeal red blood cell (RBC) preservation have incrementally prolonged the viability of stored RBCs. With contemporary preservative solutions, the accepted duration of RBC storage has now been extended to 42 days (1). In the past two decades, there has been increased interest in the time-dependent changes in RBC quantity and quality during this storage period. 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) (3-6) as well as risk-adjusted mortality (7-10). Multiple publications have suggested that these associations become more significant with increased duration of RBC storage (8,(11)(12)(13). In a database analysis, Koch and colleagues found an association of RBC storage duration with mortality in patients undergoing cardiac surgery (8). This association was largely driven by an increased rate of respiratory complications. However, the observational nature of this investigation and concerns over residual confounding preclude definitive statements regarding causality. Moreover, evidence to the contrary exists as well (14-17), and the impact of RBC storage duration on development of transfusion-related complications remains a matter of debate (18,19).While the majority of TRALI cases are believed to be the result of an interaction between donor anti-HLA or anti-leukocyte antibodies and the cognate antigen on recipient leukocytes (20), a second "two-hit" model for TRALI has also been described (21). This model suggests that in a "primed" host, infusion of Author Contributions: D.J.K. contributed to the acquisition of data, and analysis and interpretation of the study results. R.K. contributed to the study design and procedures and the acquisition of the data. R.B.W. contributed to the study conception and design as well as the interpretati...

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“…That same year, Keller and her colleagues issued a preliminary report describing an increased hospital length of stay in patients who received older red blood cell products [46]. However, there was no correlation ICU length of stay or ventilator days.…”

Section: Data From Clinical Studiesmentioning

confidence: 99%

Current issues relating to the transfusion of stored red blood cells

Zimrin¹,

2009

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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.

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Effects of Age of Transfused Blood on Length of Stay in Trauma Patients: A Preliminary Report

Cited by 84 publications

References 3 publications

Early massive transfusion in trauma patients: Canadian single-centre retrospective cohort study

Early massive transfusion in trauma patients: Canadian single-centre retrospective cohort study

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

Current issues relating to the transfusion of stored red blood cells

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