Red blood cell storage duration is not associated with clinical outcomes for acute chest syndrome in children with sickle cell disease

Abstract

Background Providers commonly transfuse sickle cell disease (SCD) patients with fresh red blood cells (RBCs) as treatment for acute chest syndrome (ACS). The objective of this study is to determine if there is an association between the storage duration of RBCs and length of hospitalization and oxygen requirement after transfusion in pediatric SCD patients with ACS. Study Design and Methods This is a retrospective cohort study of pediatric SCD patients with ACS treated with a simple RBC transfusion over 8.5 years at a single institution. Multivariate generalized estimation equation analysis was used to identify associations between storage duration of RBCs and outcome measures. Results Two hundred thirty-four ACS episodes in 131 subjects were included. The median storage duration of the oldest unit of transfused RBCs was 17 days (IQR 11 – 26). The majority of ACS episodes, 77.4% were treated with 1 unit of transfused RBCs, 20.9% received 2 units and 1.7% received 3 or more units of RBCs. There was no association between the storage duration of the oldest unit of transfused RBCs, and either duration of hospitalization or supplemental oxygen requirement after transfusion in multivariate analyses. Conclusion This retrospective study is one of the first to investigate the role of the storage lesion in children with SCD, and does not support the preferential transfusion of fresh RBCs for ACS. Ultimately, a randomized controlled trial (RCT) is necessary to determine whether the storage age of RBCs affects outcomes for patients with SCD and ACS.

Red blood cell transfusions during sickle cell anemia vaso‐occlusive crises: a report from the magnesium in crisis (MAGiC) study

“…Collecting prospective data on transfusion indications, Hb concentration before transfusion, and transfusion outcomes including RBC alloimmunization are necessary first steps. Development and validation of tools to support clinicians' decision making about transfusions, such as a tool to predict ACS severity and outcomes, should follow so that transfusions are prescribed when the benefits outweigh the risks.…”

How I reduce the risk of missed irradiation transfusion events in children

“…In centers that care for patients with sickle cell disease or thalassemia, who do not require irradiated blood, this approach may work well, as providers can remove the requirement for irradiation for these patients. Although the freshness of the RBC product does not appear to impact the outcome of patients with acute chest syndrome, concerns over the storage lesion of older irradiated blood may be compelling enough to wish to provide nonirradiated or freshly irradiated blood to these patients if irradiated blood is used …”

“…Although the freshness of the RBC product does not appear to impact the outcome of patients with acute chest syndrome, concerns over the storage lesion of older irradiated blood may be compelling enough to wish to provide nonirradiated or freshly irradiated blood to these patients if irradiated blood is used. 16 Although the default irradiation with option to remove approach can be compelling for some centers, there are downsides. I have found examples of requests to remove irradiation by a provider when the patient had an indication for irradiation.…”

The use of rejuvenated red blood cells for transfusion in patients with sickle cell anemia

“…One retrospective study evaluated the impact of transfusion storage age in pediatric patients with SCA and acute chest syndrome. They found no association between the age of blood transfused and patient length of stay or duration of supplemental oxygen requirement . The Tissue Oxygenation by Transfusion in Severe Anemia with Lactic Acidosis (TOTAL) trial randomized 290 pediatric patients, the majority of whom were affected by malaria (81%) or SCA (13%), to receive transfusion of units stored 1 to 10 days (mean, 8 days) versus 25 to 35 days (mean, 32 days).…”