title: Fresh red blood cell transfusion and short-term pulmonary, immunologic, and coagulation status: a randomized clinical trial.
abstract: BACKGROUND
  Transfusion-related pulmonary complications are leading causes of morbidity and mortality attributed to transfusion. Observational studies suggest an important role for red blood cell (RBC) storage duration in these adverse outcomes.
  
  
  OBJECTIVE
  To evaluate the impact of RBC storage duration on short-term pulmonary function as well as immunologic and coagulation status in mechanically ventilated patients receiving RBC transfusion.
  
  
  METHODS
  This is a double-blind, randomized, clinical trial comparing fresh (≤5 d of storage) versus standard issue single-unit RBC transfusion in adult intubated and mechanically ventilated patients. The primary outcome is the change in pulmonary gas exchange as assessed by the partial pressure of arterial oxygen to fraction of inspired oxygen concentration ratio (ΔPa(O(2))/Fi(O(2))). Secondary outcomes include changes in immune and coagulation status.
  
  
  RESULTS
  Fifty patients were randomized to receive fresh RBCs and an additional 50 patients to standard issue RBCs. Median storage age was 4.0 days (interquartile range, 3.0-5.0) and 26.5 days (interquartile range, 21.0-36.0) in the fresh RBC group and standard issue RBC group, respectively. No differences were noted in the primary outcome of ΔPa(O(2))/Fi(O(2)) (difference between the mean ΔPa(O(2))/Fi(O(2)) in the standard issue RBC group vs. the fresh RBC group, -11.5; 95% confidence interval, -35.3 to 12.3; P = 0.22). Similarly, no significant differences were noted in markers of immunologic or coagulation status.
  
  
  CONCLUSIONS
  In this randomized clinical trial, no differences were noted in early measures of pulmonary function or in immunologic or coagulation status when comparing fresh versus standard issue single-unit RBC transfusion. Clinical trial registered with ClinicalTrials.gov (NCT00751322).
authors.affiliation: Division of Critical Care Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA. kor.daryl@mayo.edu
authors.forename: Daryl J
authors.initials: DJ
authors.lastname: Kor
authors.forename: Rahul
authors.initials: R
authors.lastname: Kashyap
authors.forename: Richard B
authors.initials: RB
authors.lastname: Weiskopf
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Wilson
authors.forename: Camille M
authors.initials: CM
authors.lastname: van Buskirk
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Winters
authors.forename: Michael
authors.initials: M
authors.lastname: Malinchoc
authors.forename: Rolf D
authors.initials: RD
authors.lastname: Hubmayr
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001771:Blood Banks; D001778:Blood Coagulation Disorders / Q000453:epidemiology / Q000209:etiology*; D001793:Blood Preservation / Q000009:adverse effects* / Q000379:methods; D058731:Blood Safety; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D004311:Double-Blind Method; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D008171:Lung Diseases / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011659:Pulmonary Gas Exchange; D012016:Reference Values; D012121:Respiration, Artificial; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers