Fresh Red Blood Cells No Better Than Older Ones

The use of fresh red blood cells (RBCs), rather than standard-issue RBCs, does not demonstrate a benefit in the treatment of critically ill pediatric patients, according to a new study.

Researchers at Université Laval (Quebec City, Canada), Washington University (WUSTL; St. Louis, MO, USA), the London School of Economics (United Kingdom), and other institutions conducted an international, randomized clinical trial to determine if transfusion of fresh RBCs reduced new or progressive multiple organ dysfunction syndrome (MODS), compared to standard-issue RBCs. In all, 1,461 patients (median age 1.8 years; 47.3% girls) were randomized on a 1:1 basis to fresh or standard-issue RBC groups. The main outcome was MODS, measured for 28 days or to discharge or death.

The results revealed no significant differences in new or progressive MODS in children between the fresh RBC (20.2%) and standard-issue RBC (18.2%) groups. The prevalence of sepsis was 25.8% in the fresh group and 25.3% in the standard-issue group; the prevalence of acute respiratory distress syndrome was 6.6% in the fresh group and 4.8% in the standard-issue group; and intensive care unit (ICU) mortality was 4.5% in the fresh RBC group, compared to 3.5 % in the standard-issue RBC group. The study was published on December 10, 2019, in JAMA.

“Our findings indicate that doctors should not be afraid to use older red cells in critically ill children. Those who are showing a preference for fresh red cells might consider discontinuing this practice unless there are extenuating circumstances,” said co-lead author Philip Spinella, MD, of the WUSTL pediatric critical care translational research program. “The findings also provide good news for blood banks, which will likely feel less pressure to respond to requests for fresh red cells.”

RBC transfusions are commonly given to critically ill children for conditions such as trauma, cancer chemotherapy, intraoperative bleeding, as well as for chronic conditions, such as thalassemia and sickle cell disease. Transfusing the oldest RBCs in the stored inventory first is standard practice among many hospitals. However, some hospitals preferentially give fresh RBCs to critically ill children, even though clinical studies supporting the benefits of this practice have been lacking.

Related Links:
Université Laval
Washington University
London School of Economics