Transfusion of Stored Red Blood Cells in Critical Illness: Impact on Tissue Oxygenation

Abstract

Blood transfusion is a common requirement in the intensive care setting. Improved tissue oxygenation is the therapeutic objective of transfusion for normovolaemic anaemia. However, the efficiency with which red blood cells (RBCs) carry oxygen to the tissues has been questioned, particularly after prolonged storage. We measured the impact on oxygen transport variables (base excess, lactate and ScvO 2 ) of transfusion of a unit of stored RBCs in 45 critically ill adults. There were no significant changes in these variables, except for ScvO 2 , which increased with older units (≥ 20 days storage), suggesting impaired oxygen uptake by the tissues. The role of the storage lesion (structural and functional changes in the RBC acquired in storage media) is discussed with reference to its impact on oxygen delivery.

Critical care in emergency department: massive haemorrhage in trauma

“…Transfusion is commonly required in the ICU setting but stored blood may be ineffective in improving oxygen delivery to the tissues23 and may have a deleterious effect on immune function; worsening acute lung injury and prolonging length of stay. Transfusion triggers, targeting Hb concentration, have been investigated in a number of studies.…”

Nutritional Supplementation of Donors May Improve Outcomes Following the Transfusion of Stored Red Blood Cells

“…These investigations have assessed post-transfusion differences in clinical outcomes not only in adults but also in the pediatric population. Studies have reported an increase in morbidity and mortality upon transfusing older stored RBCs in situations such as acute trauma requiring large volumes of transfused blood, cardiovascular surgery, adult critical care, and pediatric medicine (Gorman et al, 2008;Nee et al, 2010;Gauvin et al, 2010;Vandromme et al, 2009).…”

Re-Assessing Red Blood Cell Storage

“…A study at the Cleveland Clinic cast doubts about the survivability of RBCs even after a short storage interval of 14 days [9]. Additional published reports have also observed complications, post-transfusion of "old" RBCs, in critically ill patients, the pediatric population, and in individuals requiring large amounts of transfused blood, such as occurs in trauma with extensive blood loss [10][11][12].…”