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Perspectives on the impact of storage duration on blood quality and transfusion outcomes.

ABSTRACT: Red blood cells (RBCs) may be stored up to 42 days before transfusion, per US and EU standards. Although there is ample evidence that RBCs undergo deleterious changes during storage, studies assessing outcomes relative to storage time report conflicting findings. This study investigated RBC storage duration perspectives and practices among blood banking and transfusion professionals.A survey was administered at the American Association of Blood Banking annual meeting in October 2014 (N = 69).On average, participants believed RBC storage should not exceed 34 days (median: 35; range: 1-52), and estimated that RBCs are typically stored 21 days before transfusion at their institutions (median: 20; range: 10-40). There was 97% agreement that minimizing/reversing changes during RBC storage may produce clinical benefits; however, 80% believed the research does not consistently demonstrate worse outcomes using older blood. Two-thirds agreed that RBC storage duration is a major concern, but 81% agreed most institutions are not pursuing measures to shorten storage.This study found that many transfusion professionals believe RBCs should be stored for fewer than the 42 days currently allowed and that further efforts are warranted to abrogate changes in stored RBCs. These findings suggest a need for increased awareness of potential consequences of extended RBC storage and for strategies to maximize transfusion benefits.

SUBMITTER: Roback JD

PROVIDER: S-EPMC5132125 | biostudies-literature | 2016 Nov

REPOSITORIES: biostudies-literature

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Perspectives on the impact of storage duration on blood quality and transfusion outcomes.

Roback J D JD

Vox sanguinis 20160823 4

<h4>Background & objectives</h4>Red blood cells (RBCs) may be stored up to 42 days before transfusion, per US and EU standards. Although there is ample evidence that RBCs undergo deleterious changes during storage, studies assessing outcomes relative to storage time report conflicting findings. This study investigated RBC storage duration perspectives and practices among blood banking and transfusion professionals.<h4>Materials & methods</h4>A survey was administered at the American Association ...[more]

PMID: 27552072

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Project description:BACKGROUND:Platelets (PLTs) are usually stored for up to 5 days prior to transfusion, although in some blood services the storage period is extended to 7 days. During storage, changes occur in both PLT and storage medium, which may lead to PLT activation and dysfunction. The clinical significance of these changes remains uncertain. METHODS:We performed a systematic review to assess the association between PLT storage time and clinical or transfusion outcomes in patients receiving allogeneic PLT transfusion. We searched studies published in English between January 2000 and July 2017 identified from MEDLINE, Embase, PubMed and the Cochrane Libraries. RESULTS:Of the 18 studies identified, five included 4719 critically ill patients (trauma, post-cardiac surgery and a heterogeneous population of critically ill patients) and 13 included 8569 haematology patients. The five studies in critically ill patients were retrospective and did not find any association between PLT storage time when PLTs were stored for up to 5 days and mortality. There was also no association between older PLTs and sepsis in the two largest studies (n?=?4008 patients). Of the 13 studies in haematology patients, seven analysed prolonged storage time up to 6.5 or 7 days. Administration of fresh PLTs (less than 2 or 3 days) was associated with a significant increase in corrected count increment (CCI) compared to older PLTs in seven of the eight studies analysing this outcome. One single centre retrospective study found an increase in bleeding events in patients receiving older PLTs. CONCLUSIONS:PLT storage time does not appear to be associated with clinical outcomes, including bleeding, sepsis or mortality, in critically ill patients or haematology patients. The freshest PLTs (less than 3 days) were associated with a better CCI, although there was no impact on bleeding events, questioning the clinical significance of this association. However, there is an absence of evidence to draw definitive conclusions, especially in critically ill patients.

Project description:Erythrocyte cell membranes undergo morphologic changes during storage, but it is unclear whether these changes are reversible. We assessed erythrocyte cell membrane deformability in patients before and after transfusion to determine the effects of storage duration and whether changes in deformability are reversible after transfusion.Sixteen patients undergoing posterior spinal fusion surgery were studied. Erythrocyte deformability was compared between those who required moderate transfusion (? 5 units erythrocytes) and those who received minimal transfusion (0-4 units erythrocytes). Deformability was measured in samples drawn directly from the blood storage bags before transfusion and in samples drawn from patients before and after transfusion (over 3 postoperative days). In samples taken from the blood storage bags, we compared deformability of erythrocytes stored for a long duration (? 21 days), those stored for a shorter duration (<21 days), and cell-salvaged erythrocytes. Deformability was assessed quantitatively using the elongation index (EI) measured by ektacytometry, a method that determines the ability for the cell to elongate when exposed to shear stress.Erythrocyte deformability was significantly decreased from the preoperative baseline in patients after moderate transfusion (EI decreased by 12% ± 4% to 20% ± 6%; P = 0.03) but not after minimal transfusion (EI decreased by 3% ± 1% to 4% ± 1%; P = 0.68). These changes did not reverse over 3 postoperative days. Deformability was significantly less in erythrocytes stored for ? 21 days (EI = 0.28 ± 0.02) than in those stored for <21 days (EI = 0.33 ± 0.02; P = 0.001) or those drawn from patients preoperatively (EI = 0.33 ± 0.02; P = 0.001). Cell-salvaged erythrocytes had intermediate deformability (EI = 0.30 ± 0.03) that was greater than that of erythrocytes stored ? 21 days (P = 0.047), but less than that of erythrocytes stored <21 days (P = 0.03).The findings demonstrate that increased duration of erythrocyte storage is associated with decreased cell membrane deformability and that these changes are not readily reversible after transfusion.

Project description:BackgroundCardiac surgery is the most common setting for massive transfusion in medically advanced countries. Studies of massive transfusion after injury suggest that the ratios of administered plasma and platelets (PLT) to red blood cells (RBCs) affect mortality. Data from the Red Cell Storage Duration Study (RECESS), a large randomized trial of the effect of RBC storage duration in patients undergoing complex cardiac surgery, were analyzed retrospectively to investigate the association between blood component ratios used in massively transfused patients and subsequent clinical outcomes.MethodsMassive transfusion was defined as those who had ≥6 RBC units or ≥8 total blood components. For plasma, high ratio was defined as ≥1 plasma unit:1 RBC unit. For PLT transfusion, high ratio was defined as ≥0.2 PLT doses:1 RBC unit; PLT dose was defined as 1 apheresis PLT or 5 whole blood PLT equivalents. The clinical outcomes analyzed were mortality and the change in the Multiple Organ Dysfunction Score (ΔMODS) comparing the preoperative score with the highest composite score through the earliest of death, discharge, or day 7. Outcomes were compared between patients transfused with high and low ratios. Linear and Cox regression were used to explore relationships between predictors and continuous outcomes and time to event outcomes.ResultsA total of 324 subjects met the definition of massive transfusion. In those receiving high plasma:RBC ratio, the mean (SE) 7- and 28-day ΔMODS was 1.24 (0.45) and 1.26 (0.56) points lower, (P = .007 and P = .024), respectively, than in patients receiving lower ratios. In patients receiving high PLT:RBC ratio, the mean (SE) 7- and 28-day ΔMODS were 1.55 (0.53) and 1.49 (0.65) points lower (P = .004 and P = .022), respectively. Subjects who received low-ratio plasma:RBC transfusion had excess 7-day mortality compared with those who received high ratio (7.2% vs 1.7%, respectively, P = .0318), which remained significant at 28 days (P = .035). The ratio of PLT:RBCs was not associated with differences in mortality.ConclusionsThis analysis found that in complex cardiac surgery patients who received massive transfusion, there was an association between the composition of blood products used and clinical outcomes. Specifically, there was less organ dysfunction in those who received high-ratio transfusions (plasma:RBCs and PLT:RBCs), and lower mortality in those who received high-ratio plasma:RBC transfusions.

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Perspectives on the impact of storage duration on blood quality and transfusion outcomes.

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Perspectives on the impact of storage duration on blood quality and transfusion outcomes.

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