Abstract Background The duration of red blood cell (RBC) storage may have a negative impact on endothelial nitric oxide bioavailability. We tested the hypothesis that transfused fresh blood will have ...a more favourable effect on microvascular endothelial function as compared to older standard issue blood. Methods Participants requiring chronic RBC transfusions were enrolled in a crossover-design study to receive fresh (less than 7 days storage) or standard (up to 42 days storage) blood on two separate visits. Endothelial function was assessed by Reactive Hyperaemia Peripheral Arterial Tonometry (Rh-PAT) that was measured prior to and following transfusions. For each participant, the difference between endothelial function pre and post transfusion was assessed in relation to blood storage time. Results Twenty one patients (71 ± 16 years, 52% females) were enrolled. Mean age of fresh blood was 5.5 days ±1.0 and of standard blood was 24.5 days ±7.9 days. The pre-transfusion haemoglobin was 83.1 ± 2.5 g/L and post-transfusion 98.9 ± 2.6 g/L. An average of 2 units of packed Red Blood Cells ( pRBCs) were transfused. Microvascular endothelial function decreased more frequently after transfusion of standard blood compared to fresh blood. Standard issue blood transfusion was associated with decrease in Rh-PAT index (−0.25 ± 0.63) compared to fresh blood (+0.03 ± 0.49), P = .026. Conclusion Transfusions of standard issue blood is associated with less favourable effect on microvascular endothelial function as compared to fresh blood.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Quality of red blood cells (RBCs) varies depending on the method of processing the whole blood donation, and the method of processing might affect outcomes in patients transfused RBCs. We aimed to ...establish whether an association exists between in-hospital mortality and RBC processing method and duration of storage.
We did a retrospective registry cohort study using data from three acute care hospitals in Hamilton, ON, Canada, and Canadian Blood Services over a 6-year period (2008-14). Adult patients (≥18 years) who were admitted to hospital and who received RBC transfusions were included in the study. All transfused RBCs were characterised by the method of processing (red cell filtered or whole blood filtered) and storage age (fresh 1-7 days, mid 8-35 days, and old 36-42 days). The primary outcome was in-hospital mortality. We used Cox proportional hazards regression with time-dependent stratification variables and fixed stratification variables, and controlled for patient covariates.
Between April 1, 2008, and March 31, 2014, 91 065 RBC transfusions were given to 23 634 adults who were included in the analyses. When storage duration was included in the model, in-hospital mortality was significantly increased with fresh whole blood filtered units compared with the reference group of mid-age red cell filtered units (hazard ratio 2·19, 95% CI 1·09-4·42; p=0·033). Differences between other age and processing categories were not significant.
The potential effect of whole blood processing methods on patient outcomes is worthy of further investigation, since adverse outcomes could be reduced by minor changes to blood processing methods and inventory management policies.
Canadian Blood Services, Health Canada, and the Canadian Institutes of Health Research.
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