A patient recovering from long term critical illness was found to have a Hb of 65G/L.
You request 3 units of packed RBCs. The blood bank informs you that the patient has an uncommon blood group and the only blood available although safe, is nearing the end of its storage life.
Outline the factors that may contribute to the reduced efficacy of such blood and what clinical consequences might be expected?
Storage lesions begin after 2 to 3 weeks of storage and progress with duration of storage – with storage RBCs undergo structural and functional changes that may reduce function and viability after transfusion.
Effects include:
Transfusion of red cells stored for more than 14 days has been associated with increased peri operative complications , organ failure , sepsis and
mortality after cardiac surgery ( Koch, NEJM: 2008 ).
In particular survival in the first 6 months after surgery was reduced.
Other studies have demonstrated an association between an increased duration of storage and multiorgan failure, sepsis and death in other populations including post surgical and general ICU patients.
Storage lesions of packed red blood cells are discussed in greater detail elsewhere.
One can also find an (out of date) Blood Service Policy on "The Age of Red Cells" from the Australian Red Cross.Theoretical objections to the use of old PRBCs are raised by Aubron et al in their 2013 article.
In brief summary, the storage lesions are as follows:
Thus, the almost-expired blood has a number of disadvantages:
The clinical consequences of transfusing someone with such blood?
However, on meta-analysis, some of the other adverse effect risks were not supported:
More recent evidence from the ABLE trial (Lacroix et al, 2015) confirms essentially all of the above. The authors could not find any difference in any of the outcomes between the patients who got 6-day-old cells and those who got 22-day-old cells. Results of the AustralianTRANSFUSE study are still awaited, but generally speaking it is becoming apparent that the theoretical disadvantages of using older PRBCs do not materialise in practice.
Wang, Dong, et al. "Transfusion of older stored blood and risk of death: a meta‐analysis." Transfusion 52.6 (2012): 1184-1195.
Aubron, Cécile, et al. "Age of red blood cells and transfusion in critically ill patients." Ann Intensive Care 3.1 (2013): 2.
Koch, Colleen Gorman, et al. "Duration of red-cell storage and complications after cardiac surgery." New England Journal of Medicine 358.12 (2008): 1229-1239.
Lacroix, Jacques, et al. "The Age of Blood Evaluation (ABLE) randomized controlled trial: study design." Transfusion medicine reviews 25.3 (2011): 197-205.