No Advantage for Fresh Blood in ICU Transfusions

A new study has found that for critically ill patients, transfusing fresher red blood cells (RBCs) does not translate into better outcomes.

Researchers at the Mayo Clinic (Rochester, MN, USA) conducted a retrospective matched cohort study involving 99 patients who received fresh RBCs and 99 controls. The researchers compared nosocomial infections, organ dysfunction scores, transfusion reactions, 30-day mortality and hospital and intensive care unit (ICU) lengths of stay between ICU patients who received either exclusively "fresh" (less than 8 days) RBCs and those who received at least one unit of "old" (over 14 days) RBCs. Study participants were matched by the exact number of units transfused, exact number of leukoreduced units, age, admission source and primary body system disease.

The results showed that there was no evidence for adverse effects with the administration of one or more units of aged RBCs for any of the outcomes assessed. Rates of overall complications between RBC transfusion cohorts were 1% (fresh) and 2% (old). Nosocomial infections were seen in 9.1% of fresh blood recipients versus 2% of old blood recipients. Morbidity, as marked by a change in sequential organ failure assessment (SOFA) score, was comparable between groups, as was hospital and ICU length of stay. The overall mortality rate was 20 (20.2%) versus 9 (9.1%), respectively. The study was presented at the American Society of Anesthesiologists (ASA) annual meeting, held during October 2012 in Washington DC (USA).

“Our findings suggest that there is no difference in the outcomes of critically ill patients who receive exclusively fresh RBCs versus those who receive at least one unit of older RBCs,” concluded lead author Leanne Clifford, BM, and colleagues. “This evidence contrasts with previous results suggesting that older RBCs may be harmful. Ongoing randomized controlled trials may help to address this ongoing equipoise.”

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