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Review
. 2012 Jun;52(6):1184-95.
doi: 10.1111/j.1537-2995.2011.03466.x. Epub 2011 Dec 21.

Transfusion of older stored blood and risk of death: a meta-analysis

Dong Wang  1 , Junfeng Sun, Steven B Solomon, Harvey G Klein, Charles Natanson
Affiliations
Review

Transfusion of older stored blood and risk of death: a meta-analysis

Dong Wang et al. Transfusion. 2012 Jun.

Abstract

Background: Blood for transfusion is stored for up to 42 days. Older blood develops lesions and accumulates potentially injurious substances. Some studies report increasing toxicity as blood ages. We assessed the safety of transfused older versus newer stored blood.

Study design and methods: PubMed, Scopus, and Embase were searched using terms new and old and red blood cell and storage through May 6, 2011, for observational and randomized controlled studies comparing outcomes using transfused blood having longer and shorter storage times. Death was the outcome of interest.

Results: Twenty-one studies were identified, predominantly in cardiac surgery (n=6) and trauma (n=6) patients, including 409,966 patients. A test for heterogeneity of these studies' results was not significant for mortality (I(2)=3.7%, p=0.41). Older blood was associated with a significantly increased risk of death (odds ratio, 1.16; 95% confidence interval [CI], 1.07-1.24). Using available mortality data, 97 (95% CI, 63-199) patients need to be treated with only new blood to save one life. Subgroup analysis of these trials indicated that the increased risk was not restricted to a particular type of patient, size of trial, or amount of blood transfused.

Conclusion: Based on available data, use of older stored blood is associated with a significantly increased risk of death.

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Figures

Figure 1
Figure 1
Study selection
Figure 2
Figure 2. Funnel plot of studies included in meta-analysis
Each open circle represents one of 21 studies in our meta-analysis. The precision for each study is plotted versus log (OR). The circles are distributed equally around the solid vertical line with a solid diamond at the bottom, representing the overall treatment effect in this study. There is no skewed distribution of studies giving evidence for a publication bias. Eggers test for publication bias (or small study effect) is non-significant (P=0.43) and confirm what is seen on visual expectedness.
Figure 3
Figure 3. Mortality
The size of the data markers is proportional to the inverse variance of each point estimate.
Figure 4
Figure 4
Severe adverse effects.
Figure 5
Figure 5
Subgroup analysis (Patient types).
Figure 6
Figure 6
Subgroup analysis (Pediatric and Adult).
Figure 7
Figure 7
Subgroup analysis (Adjusted mortality versus counts).
See this image and copyright information in PMC

Comment in

References

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    1. Whitaker BI, Schlumpf K Schulman J, Green J. The 2009 Nationwide Blood Collection and Utilization Survey Report. Besthesda, MD: 2011. ISBN.
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    1. Heaton WA, Holme S, Smith K, et al. Effects of 3-5 log10 pre-storage leucocyte depletion on red cell storage and metabolism. Br J Haematol. 1994;87(2):363–368. - PubMed

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