Does prolonged storage of red blood cells cause harm?
Red blood cells (RBCs) degrade progressively during the weeks of refrigerated storage. No universally accepted definition of 'fresh' or 'old' RBCs exists. While practices vary from country to country, preservative solutions permitting shelf life as long as 7 weeks have been licenced. Transfusion of stored RBCs, particularly those at the end of the approved shelf life, has been implicated in adverse clinical outcomes. The results of observational analyses, animal models and studies in volunteers have proved provocative, controversial and contradictory. A recently completed randomized controlled trial (RCT) in premature infants exemplifies the difficulties with moderately sized clinical studies. Several other RCTs are in progress. The effect of RBC storage may well vary according to the clinical setting. Resolution of the importance of the storage lesion may require large pragmatic clinical trials. In the meantime, institutions involved in blood collection and transfusion should explore strategies that assure blood availability, while limiting the use of the oldest RBCs currently approved by regulation.
Department of Transfusion Medicine and Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
Willy A
WA
Flegel
Charles
C
Natanson
Harvey G
HG
Klein
D000818:Animals; D001793:Blood Preservation / Q000009:adverse effects*; D001803:Blood Transfusion; D004912:Erythrocytes / Q000502:physiology*; D006801:Humans; D015201:Meta-Analysis as Topic; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D013997:Time Factors
adverse effects; red blood cells; red cell units; storage; therapy