title: The association between the transfusion of older blood and outcomes after trauma.
abstract: Allogeneic packed red blood cells (PRBCs) suppress immunity and influence outcomes. The influence of blood on the risk of infection and death may be related to the duration of storage. We sought to determine whether blood storage duration was associated with infection or death in a large cohort of injury victims. We reviewed a cohort of trauma patients transfused at least 1 U of PRBCs within 24 h of admission to a level 1 trauma center. The outcomes of interest were complicated sepsis and mortality. We compared the amount of older blood (>14 days storage) given to patients who did or did not develop the outcomes of interest using univariate and multivariate methods. A total of 820 patients were included. Patients who died (n = 117) received more units of older blood than those who lived (5 U [inter quartile range {IQR}, 2-9] vs. 3 U [IQR, 2-6]; P < 0.001). Patients with complicated sepsis (n = 244) received a greater volume of older blood than those without complicated sepsis (6 U [IQR, 2-10] vs. 3 U [IQR, 1-5]; P < 0.001). After adjusting for clinical factors, including the total amount of blood transfused, patients receiving greater than or equal to 7 U of older blood had a higher risk of complicated sepsis than patients receiving 1 or fewer units (odds ratio, 1.9; P = 0.03). The risk for complicated sepsis and death in trauma victims who are transfused blood is high. The amount of older blood transfused is associated with complicated sepsis. Although the best strategy to minimize the effects of allogeneic blood is to avoid unnecessary transfusions, it may be particularly important to avoid transfusing multiple units of older blood.
authors.affiliation: Harborview Medical Center, University of Washington, Seattle, WA 98104-2499, USA.
authors.forename: Monique
authors.initials: M
authors.lastname: Hassan
authors.forename: Tam N
authors.initials: TN
authors.lastname: Pham
authors.forename: Joseph
authors.initials: J
authors.lastname: Cuschieri
authors.forename: Keir J
authors.initials: KJ
authors.lastname: Warner
authors.forename: Theresa
authors.initials: T
authors.lastname: Nester
authors.forename: Ronald V
authors.initials: RV
authors.lastname: Maier
authors.forename: Sherene
authors.initials: S
authors.lastname: Shalhub
authors.forename: Grant E
authors.initials: GE
authors.lastname: O'Keefe
mesh_terms: D001793:Blood Preservation / Q000009:adverse effects; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000401:mortality*; D006801:Humans; D015999:Multivariate Analysis; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*
references.citation: J Trauma. 2005 Jul;59(1):19-23; discussion 23-4
references.pmid: 16096534
references.citation: Shock. 2003 Dec;20(6):497-502
references.pmid: 14625472
references.citation: Br J Haematol. 1998 May;101(2):364-8
references.pmid: 9609536
references.citation: J Clin Invest. 1998 Apr 1;101(7):1458-67
references.pmid: 9525989
references.citation: Transfusion. 2007 Apr;47(4):599-607
references.pmid: 17381617
references.citation: Shock. 2007 Aug;28(2):165-71
references.pmid: 17529904
references.citation: Arch Surg. 2002 Jun;137(6):711-6; discussion 716-7
references.pmid: 12049543
references.citation: J Trauma. 2002 May;52(5):817-25; discussion 825-6
references.pmid: 11988644
references.citation: Arch Surg. 1997 Jun;132(6):620-4; discussion 624-5
references.pmid: 9197854
references.citation: Arch Surg. 1994 Jan;129(1):39-45
references.pmid: 8279939
references.citation: J Trauma. 2008 Aug;65(2):279-82; discussion 282-4
references.pmid: 18695462
references.citation: J Trauma. 2009 Jan;66(1):115-22; discussion 122-3
references.pmid: 19131814
references.citation: Vox Sang. 1992;63(2):133-6
references.pmid: 1332255
references.citation: J Med. 1994;25(6):353-61
references.pmid: 7769373
references.citation: Arch Pathol Lab Med. 2007 May;131(5):708-18
references.pmid: 17488156
references.citation: Transfusion. 2009 Jul;49(7):1384-94
references.pmid: 19453985
references.citation: Transfusion. 1997 Jul;37(7):719-26
references.pmid: 9225936
references.citation: J Trauma. 2006 Aug;61(2):436-9
references.pmid: 16917462
references.citation: Chest. 1992 Jun;101(6):1644-55
references.pmid: 1303622
references.citation: J Surg Res. 2002 Jan;102(1):6-12
references.pmid: 11792145
references.citation: Transfus Sci. 1997 Sep;18(3):447-58
references.pmid: 10175158
references.citation: N Engl J Med. 2008 Mar 20;358(12):1229-39
references.pmid: 18354101
references.citation: Transfus Med. 2008 Aug;18(4):260-5
references.pmid: 18783585
references.citation: Crit Care Med. 2004 Jan;32(1):39-52
references.pmid: 14707558
references.citation: N Engl J Med. 1999 Feb 11;340(6):409-17
references.pmid: 9971864