title: Impact of the age of transfused red blood cells in the trauma population: a feasibility study.
abstract: Following injury, transfusion of red blood cells (RBCs) of increased storage duration has been associated with an increased morbidity and mortality. Prospective trials focusing on the impact of the storage age of RBCs in severely bleeding trauma patients have failed to accrue patients. This has been attributed to an inability to maintain a large inventory of fresh RBCs, and the difficulties in obtaining consent in severely bleeding trauma patients. To address these issues, we performed a prospective, observational pilot study to evaluate the feasibility of conducting a trial focusing on RBC age in patients following injury.
  
  
  METHODS
  Patients with bleeding due to trauma were transfused RBCs ≤10 day old if they were ABO blood Type O (Group O) or were transfused the oldest RBCs in inventory if they were Type A, B or AB (Group A/B/AB). Clinicians were unaware of the specific age of the RBCs.
  
  
  RESULTS
  63 patients were analyzed (Group O, n=19; Group A/B/AB, n=44). Half of all patients had severe injuries ISS (median 22). The median admission base deficit was -5 mEq/L, and median total 24h use of RBC and FFP was 1.2 L. The age of RBCs transfused to Group O was significantly lower than for Group A/B/AB [median (IQR) A/B/AB=18.4 (11.4-25.4) days, and Group O=6 (4.2-7.8) days; p<0.001].
  
  
  CONCLUSIONS
  It appears feasible to conduct a RBC age trial in trauma patients using ABO blood type to construct comparative groups. Adequate RBC age separation between cohorts and reduced RBC age in the "young" group of patients who received units ≤10 days old was achieved.
authors.affiliation: University of Texas Health Science Center at San Antonio, Department of Surgery, Division of Trauma and Emergency Surgery, 7703 Floyd Curl Drive, MC 7740, San Antonio, TX 78229, United States. Electronic address: cohn@uthscsa.edu.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Cohn
authors.affiliation: University of Texas Health Science Center at San Antonio, Department of Surgery, Division of Trauma and Emergency Surgery, 7703 Floyd Curl Drive, MC 7740, San Antonio, TX 78229, United States.
authors.forename: Mark
authors.initials: M
authors.lastname: DeRosa
authors.affiliation: University of Texas Health Science Center at San Antonio, Department of Surgery, Residency Office, 7703 Floyd Curl Drive, MC 78229, San Antonio, TX 78229, United States.
authors.forename: Ashwini
authors.initials: A
authors.lastname: Kumar
authors.affiliation: University of Texas Health Science Center at San Antonio, Department of Pathology, 7703 Floyd Curl Drive, MC 7750, San Antonio, TX 78229, United States.
authors.forename: Chantal
authors.initials: C
authors.lastname: Harrison
authors.affiliation: University of Texas Health Science Center at San Antonio, Department of Surgery, Division of Trauma and Emergency Surgery, 7703 Floyd Curl Drive, MC 7740, San Antonio, TX 78229, United States.
authors.forename: Daniel
authors.initials: D
authors.lastname: Dent
authors.affiliation: University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States.
authors.forename: Sunthosh
authors.initials: S
authors.lastname: Sivam
authors.affiliation: University of Texas Health Science Center at San Antonio, Department of Surgery, Division of Trauma and Emergency Surgery, 7703 Floyd Curl Drive, MC 7740, San Antonio, TX 78229, United States.
authors.forename: Janet
authors.initials: J
authors.lastname: McCarthy
authors.affiliation: University Health System, 4502 Medical Drive, San Antonio, TX 78229, United States.
authors.forename: Sherrie
authors.initials: S
authors.lastname: Warner
authors.affiliation: University Health System, 4502 Medical Drive, San Antonio, TX 78229, United States.
authors.forename: Susan
authors.initials: S
authors.lastname: Williams
authors.affiliation: University of Texas Health Science Center at San Antonio, Department of Epidemiology & Biostatistics, 7703 Floyd Curl Drive, MC 78229, San Antonio, TX 78229, United States.
authors.forename: Joel E
authors.initials: JE
authors.lastname: Michalek
authors.affiliation: Department of Pediatrics, Washington University in St. Louis, St Louis, MO 63110, United States.
authors.forename: Philip
authors.initials: P
authors.lastname: Spinella
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001771:Blood Banks / Q000592:standards*; D001793:Blood Preservation / Q000592:standards*; D002648:Child; D000075202:Contraindications; D016638:Critical Illness / Q000628:therapy*; D017707:Erythrocyte Transfusion; D004912:Erythrocytes / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010865:Pilot Projects; D013997:Time Factors; D014947:Wounds and Injuries / Q000097:blood / Q000628:therapy*