Bethesda, Md. - Patients who receive transfusions of “older” blood are not any more likely to die in the hospital than those who receive “fresher” blood. One of the largest studies to date examining blood age shows that there is no difference in the in-hospital mortality rate between transfusion of the freshest available red blood cells (RBCs) or so-called standard-issue RBCs. The findings are being presented at the 2016 AABB Annual Meeting, scheduled for Oct. 22-25 in Orlando, Fla.
“We can be confident that patients will not be harmed by receiving a transfusion of standard-issue red blood cells,” said lead author and AABB member Nancy Heddle, MSc, FCSMLS(D), Research Director, McMaster Centre for Transfusion Research, McMaster University.
This study — the INFORM trial (Informing Fresh Versus Old Red Cell Management) — included more than 20,000 patients at seven hospitals in four countries — Canada, United States, Australia and Israel. Researchers compared in-hospital mortality rates for patients who received either the freshest available RBCs (N=6,937) or standard-issue RBCs (N=13,922).
In-hospital mortality was 9.1% for those in the “fresher” group, compared with 8.7% for the “older” group among patients with the most common blood types, A and O. No differences in mortality were seen when all blood types were included — 9.1% vs. 8.8% respectively. The median number of storage days was 11 for the “fresher” group and 23 days for the “older” group. The research is also being published in the “New England Journal of Medicine.”
The findings are in line with AABB’s new red blood cell guidelines, announced earlier this month in the Journal of the American Medical Association, recommending that patients, including neonates requiring transfusions, receive standard-issue rather than fresh RBC units (defined as units that have been stored for less than 10 days).
“One of the biggest controversies in transfusion medicine is whether older blood is harmful,” said Dr. Aaron Tobian, one of the authors of the guidelines and chair of the AABB Clinical Transfusion Medicine Committee. He also noted “there have been 13 randomized trials of more than 5,000 patients that have evaluated the impact of fresher compared to older blood. However, no previous guidelines have made any recommendations on the red blood cell storage duration.”
In the United States, RBCs may be stored up to 42 days. Early observational studies suggested that transfusion with “older” RBCs translates to worse outcomes, like more deaths or greater organ dysfunction. More recent randomized controlled trials have shown no differences in outcomes between “fresh” blood and “older” blood. In fact, these trials suggest that patients transfused with “older” RBCs may have fewer adverse events than patients transfused with “fresher” RBCs.
“If data suggest no harm from the use of standard issue blood and fresher blood would only constrain a limited resource, continuing with standard practice is appropriate,” said Tobian.
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AABB is an international, not-for-profit association representing individuals and institutions involved in the fields of transfusion medicine and cellular therapies. The association is committed to improving health through the development and delivery of standards, accreditation and educational programs that focus on optimizing patient and donor care and safety. AABB membership includes physicians, nurses, scientists, researchers, administrators, medical technologists and other health care providers. AABB members are located in more than 80 countries and AABB accredits institutions in over 50 countries.