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. 2013 Jan 15;3(1):2.
doi: 10.1186/2110-5820-3-2.

Age of red blood cells and transfusion in critically ill patients

Cécile Aubron  1 , Alistair Nichol, D Jamie Cooper, Rinaldo Bellomo
Affiliations

Age of red blood cells and transfusion in critically ill patients

Cécile Aubron et al. Ann Intensive Care. .

Abstract

Red blood cells (RBC) storage facilitates the supply of RBC to meet the clinical demand for transfusion and to avoid wastage. However, RBC storage is associated with adverse changes in erythrocytes and their preservation medium. These changes are responsible for functional alterations and for the accumulation of potentially injurious bioreactive substances. They also may have clinically harmful effects especially in critically ill patients. The clinical consequences of storage lesions, however, remain a matter of persistent controversy. Multiple retrospective, observational, and single-center studies have reported heterogeneous and conflicting findings about the effect of blood storage duration on morbidity and/or mortality in trauma, cardiac surgery, and intensive care unit patients. Describing the details of this controversy, this review not only summarizes the current literature but also highlights the equipoise that currently exists with regard to the use of short versus current standard (extended) storage duration red cells in critically ill patients and supports the need for large, randomized, controlled trials evaluating the clinical impact of transfusing fresh (short duration of storage) versus older (extended duration of storage) red cells in critically ill patients.

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Figures

Figure 1
Figure 1
Changes occurring in red blood cells and storage medium over the storage time. ATP adenosine triphosphate; 2,3-DPG 2,3-diphosphoglycerate; RBC red blood cells.
Figure 2
Figure 2
Hospital mortality (%, 95% confidence interval) according to maximum age of red blood cells (days) from Pettila et al.[15]with permission.
Figure 3
Figure 3
Length of blood storage for positive (a[15,16,18,23,27,28,61]) and negative (b,[50-55,58,62]) studies. The age of blood is expressed as the mean age or the median age of all RBC units, or in some studies as the median of the oldest (or oldest and second oldest) RBC units. The figures give the age of blood for each study comparing the primary study outcome. For instance, if the study outcome is TRALI, the figure shows the age of blood in the group of patients with TRALI and in the group of patients without TRALI.
See this image and copyright information in PMC

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