Longer RBC Storage Duration Is Associated With Increased Postoperative Infections in Pediatric Cardiac Surgery

Cholette, Jill M.; Pietropaoli, Anthony P.; Henrichs, Kelly; Alfieris, George M.; Powers, Karen S.; Phipps, Richard P.; Spinelli, Sherry L.; Swartz, Michael F.; Gensini, Francisco; Daugherty, L. Eugene; Nazarian, Emily; Rubenstein, Jeffrey S.; Sweeney, Dawn; Eaton, Michael P.; Blumberg, Neil

doi:10.1097/pcc.0000000000000320

Cited by 42 publications

(50 citation statements)

References 42 publications

(37 reference statements)

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“…For example, observational data have suggested that infection rates are strikingly higher in infants and children undergoing cardiac surgery who receive washed transfusions of older RBCs (25-38 days). 57 Researchers found that washing the RBCs that were oldest (eg, .29 days) was related to an increase in morbidity when compared with unwashed RBCs. 57 An individual patient meta-analysis from studies that enrolled infants and small children who received very large volumes of washed RBCs may be a feasible approach to explore these issues.…”

Section: Strengths and Concerns/limitationsmentioning

confidence: 99%

Transfusion of fresher vs older red blood cells in hospitalized patients: a systematic review and meta-analysis

Alexander

Barty

Fei

et al. 2016

Blood

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100

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The impact of transfusing fresher vs older red blood cells (RBCs) on patientimportant outcomes remains controversial. Two recently published large trials have provided new evidence. We summarized results of randomized trials evaluating the impact of the age of transfused RBCs. We searched MEDLINE, EMBASE, CINAHL, the Cochrane Database for Systematic Reviews, and Cochrane CENTRAL for randomized controlled trials enrolling patients who were transfused fresher vs older RBCs and reported outcomes of death, adverse events, and infection.Independently and in duplicate, reviewers determined eligibility, risk of bias, and abstracted data. We conducted random effects meta-analyses and rated certainty (quality or confidence) of evidence using the GRADE approach.

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Section: Strengths and Concerns/limitationsmentioning

confidence: 99%

Transfusion of fresher vs older red blood cells in hospitalized patients: a systematic review and meta-analysis

Alexander

Barty

Fei

et al. 2016

Blood

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100

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“…Observational studies have demonstrated an increased risk associated with red cell transfusions (9)(10)(11). This risk seems to be related to both the age and number of the units transfused.…”

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confidence: 99%

Effects of Aged Stored Autologous Red Blood Cells on Human Endothelial Function

Risbano

Kanias²,

Triulzi

et al. 2015

Am J Respir Crit Care Med

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Rationale: A major abnormality that characterizes the red cell "storage lesion" is increased hemolysis and reduced red cell lifespan after infusion. Low levels of intravascular hemolysis after transfusion of aged stored red cells disrupt nitric oxide (NO) bioavailabity, via accelerated NO scavenging reaction with cell-free plasma hemoglobin. The degree of intravascular hemolysis post-transfusion and effects on endothelial-dependent vasodilation responses to acetylcholine have not been fully characterized in humans.Objectives: To evaluate the effects of blood aged to the limits of Food and Drug Administration-approved storage time on the human microcirculation and endothelial function.Methods: Eighteen healthy individuals donated 1 U of leukopheresed red cells, divided and autologously transfused into the forearm brachial artery 5 and 42 days after blood donation. Blood samples were obtained from stored blood bag supernatants and the antecubital vein of the infusion arm. Forearm blood flow measurements were performed using strain-gauge plethysmography during transfusion, followed by testing of endotheliumdependent blood flow with increasing doses of intraarterial acetylcholine. Measurements and Main Results:We demonstrate that aged stored blood has higher levels of arginase-1 and cell-free plasma hemoglobin. Compared with 5-day blood, the transfusion of 42-day packed red cells decreases acetylcholine-dependent forearm blood flows. Intravascular venous levels of arginase-1 and cell-free plasma hemoglobin increase immediately after red cell transfusion, with more significant increases observed after infusion of 42-day-old blood.Conclusions: We demonstrate that the transfusion of blood at the limits of Food and Drug Administration-approved storage has a significant effect on the forearm circulation and impairs endothelial function. Clinical trial registered with www.clinicaltrials.gov (NCT 01137656)

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“…A higher rate of postoperative infections when RBCs older than 25 days were transfused was also detected in a trial focused on pediatric cardiac surgery. 32 In contrast, two other studies found that a storage age of RBC transfusion up to 21 to 35 days was not correlated with increased postoperative adverse events in patients undergoing cardiac surgery. 6,29 Interestingly, the cutoff used to define fresh or old blood ranged from 14 to 25 days, resulting in high heterogeneity between studies and, consequently, a difficult comparison of results.…”

Section: Subgroup Analysismentioning

confidence: 73%

mentioning

confidence: 73%

The effects of storage of red blood cells on the development of postoperative infections after noncardiac surgery

et al. 2017

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BACKGROUND: Prolonged storage of red blood cells (RBCs) is a potential risk factor for postoperative infections. The objective of this study was to examine the effect of age of RBCs transfused on development of postoperative infection. STUDY DESIGN AND METHODS: In thisprospective, double-blind randomized trial, 199 patients undergoing elective noncardiac surgery and requiring RBC transfusion were assigned to receive nonleukoreduced RBCs stored for not more than 14 days ("fresh blood" group, n 5 101) or for more than 14 days ("old blood" group, n 5 98). The primary outcome was occurrence of infection within 28 days after surgery; secondary outcomes were postoperative acute kidney injury (AKI), in-hospital and 90-day mortality, admission to intensive care unit, and hospital length of stay (LOS). As older blood was not always available, an "as-treated" (AT) analysis was also performed according to actual age of the RBCs transfused. RESULTS:The median [interquartile range] storage time of and 15 [11][12][13][14][15][16][17][18][19][20] days in fresh blood and in old blood groups, respectively. The occurrence of postoperative infection did not differ between groups (fresh blood 22% vs. old blood 25%; relative risk [RR], 1.17; confidence interval [CI], 0.71-1.93), although wound infections occurred more frequently in old blood (15% vs. 5%; RR, 3.09; CI,). Patients receiving older units had a higher rate of AKI (24% vs. 6%; p < 0.001) and, according to AT analysis, longer LOS (mean difference, 3.6 days; CI, 0.6-7.5).CONCLUSION: Prolonged RBC storage time did not increase the risk of postoperative infection. However, old blood transfusion increased wound infections rate and incidence of AKI. Immunosuppression induced by surgery and anesthesia may be aggravated by transfusion. 9 Most studies in trauma and cardiac surgery reported that prolonged RBC storage was a risk factor for postoperative infections after cardiac surgery, 10-12 but the same association was not found in liver transplantation 13 or orthopedic surgery. 14 A recent systematic review 15 that analyzed four trials which investigated the nosocomial infections, showed no benefits in receiving fresh RBCs. However, the authors reported that the results are difficult to interpret because the studies involved different populations and there were considerable differences in the length of storage of fresh and old blood and in study methods. 15To our knowledge, the association of age of RBCs with infections in noncardiac surgery population has not been investigated by double-blind randomized studies. Accordingly, the aim of this study was to investigate the relationship between RBC storage time and postoperative infection after elective noncardiac surgery. In addition, we evaluated the effects of the age of RBCs on other outcomes such as postoperative acute kidney injury (AKI), hospital length of stay (LOS), and 90-day mortality. MATERIALS AND METHODS Study populationThis prospective, randomized, controlled, double-blind clinical trial was conducted between August 2...

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Longer RBC Storage Duration Is Associated With Increased Postoperative Infections in Pediatric Cardiac Surgery

Cited by 42 publications

References 42 publications

Transfusion of fresher vs older red blood cells in hospitalized patients: a systematic review and meta-analysis

Transfusion of fresher vs older red blood cells in hospitalized patients: a systematic review and meta-analysis

Effects of Aged Stored Autologous Red Blood Cells on Human Endothelial Function

The effects of storage of red blood cells on the development of postoperative infections after noncardiac surgery

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