The Association Between the Transfusion of Older Blood and Outcomes After Trauma

Abstract

Allogeneic red blood cells (PRBCs) suppress immunity and influence outcomes. The influence of blood on the risk of infection and death may be related to the duration of storage. We sought to determine whether blood storage duration was associated with infection or death in a large cohort of injury victims. We reviewed a cohort of trauma patients transfused at least one unit of PRBCs within 24 hours of admission to a level 1 trauma center. The outcomes of interest were complicated sepsis and mortality. We compared the amount of older blood (>14 days storage) given to patients who did or did not develop the outcomes of interest using univariate and multivariate methods. A total of 820 patients were included. Patients who died (n = 117) received more units of older blood than those who lived (5 units [IQR 2–9] versus 3 units [IQR 2–6], p < 0.001). Patients with complicated sepsis (n = 244) received a greater volume of older blood than those without complicated sepsis (6 units [IQR 2–10] versus 3 units [IQR 1–5], p < 0.001). After adjusting for clinical factors including the total amount of blood transfused, patients receiving ≥7 units of older blood had a higher risk of complicated sepsis than patients receiving 1 or fewer units (OR = 1.9, p-value = 0.03). The risk for complicated sepsis and death in trauma victims who are transfused blood is high. The amount of older blood transfused is associated with complicated sepsis. While the best strategy to minimize the effects of allogeneic blood is to avoid unnecessary transfusions, it may be particularly important to avoid transfusing multiple units of older blood.

Impact of the age of stored blood on trauma patient mortality: a systematic review

“…Our search strategy is shown in Figure 2. 31 Murrell et al 36 Phelan et al 35 Spinella et al 32 Weinberg et al 33 Weinberg et al 30 Weinberg et al 34 No Definitions for the age of stored blood varied among the 7 studies. Blood was considered old if it was in storage 14 days or longer, 30,33,34 longer than 14 days, 31 or 28 days or longer.…”

“…31 Murrell et al 36 Phelan et al 35 Spinella et al 32 Weinberg et al 33 Weinberg et al 30 Weinberg et al 34 No Definitions for the age of stored blood varied among the 7 studies. Blood was considered old if it was in storage 14 days or longer, 30,33,34 longer than 14 days, 31 or 28 days or longer. 32 One study 35 used the mean age of all units received within 14 days to define new blood and the mean age of all units stored 21 days or longer to define old blood, and 1 study 36 developed a composite variable that was defined by the proportionate age of each blood unit averaged over all units transfused and then multiplied by the total number of units transfused.…”

“…Within these 7 studies, there was substantial heterogeneity in the applied defin itions for old versus new blood. The storage time after which new blood was defined as old 31 Murrell et al 36 Phelan et al 35 Spinella et al 32 Weinberg et al 33 Weinberg et al 30 Weinberg et al *Based on the Newcastle-Ottawa Quality Assessment Scale for cohort studies, each study was awarded a maximum of 1 star for each item within the Selection and Outcome categories, and a maximum of 2 stars for the Comparability category. Total scores for each study were calculated by adding 1 point for each star awarded, with a maximum possible score of 9.…”

“…Evidence for an association between the age of blood and inhospital mortality was conflicting, as 4 studies 30,32-34 found transfusion of older blood to be associated with increased mortality in trauma patients, while 3 studies 31,35,36 reported no increase in mortality associated with older versus newer blood. Two studies transfused RBCs that had been leukoreduced before storage; 1 study 35 reported no increased risk of death associated with transfusion of prestorage leukoreduced RBCs but could not determine whether the effect on mortality was neutral or protective, and another study 33 reported increased mortality associated with transfusion of older blood despite universal leukoreduction.…”

“…One study 31 examined the incidence of complicated sepsis and reported that after controlling for age, sex, ISS and total pRBC units transfused, the administration of older blood was significantly associated with the development of complicated sepsis (OR 1.9, 95% confidence interval [CI] 1.1-3.4). Another study 32 looked at the incidence of DVT and found it to be higher in patients transfused with older blood than in patients receiving newer blood ( 30 focused on outcomes in less severely injured patients and reported that the transfusion of older blood was associated with renal dysfunction (OR 1.12, 95% CI 1.02-1.23) and pneumonia (OR 1.10, 95% CI 1.04-1.17) but was not significantly associated with acute respiratory distress syndrome.…”