title: Red blood cell storage duration is not associated with clinical outcomes for acute chest syndrome in children with sickle cell disease.
abstract: BACKGROUND
  Providers commonly transfuse sickle cell disease (SCD) patients with fresh red blood cells (RBCs) as treatment for acute chest syndrome (ACS). The objective of this study was to determine if there is an association between the storage duration of RBCs and length of hospitalization and oxygen requirement after transfusion in pediatric SCD patients with ACS.
  
  
  METHODS
  This is a retrospective cohort study of pediatric SCD patients with ACS treated with a simple RBC transfusion over 8.5 years at a single institution. Multivariate generalized estimation equation analysis was used to identify associations between storage duration of RBCs and outcome measures.
  
  
  RESULTS
  A total of 234 ACS episodes in 131 subjects were included. The median storage duration of the oldest unit of transfused RBCs was 17 days (interquartile range, 11-26). The majority of ACS episodes, 77.4%, were treated with 1 unit of transfused RBCs; 20.9% received 2 units; and 1.7% received 3 or more units of RBCs. There was no association between the storage duration of the oldest unit of transfused RBCs and either duration of hospitalization or supplemental oxygen requirement after transfusion in multivariate analyses.
  
  
  CONCLUSIONS
  This retrospective study is one of the first to investigate the role of the storage lesion in children with SCD and does not support the preferential transfusion of fresh RBCs for ACS. Ultimately, a randomized controlled trial is necessary to determine whether the storage age of RBCs affects outcomes for patients with SCD and ACS.
authors.affiliation: Division of Pediatric Hematology and Oncology, Department of Pediatrics.
authors.forename: Melanie E
authors.initials: ME
authors.lastname: Fields
authors.affiliation: Division of Pediatric Hematology and Oncology, Department of Pediatrics.
authors.forename: Monica L
authors.initials: ML
authors.lastname: Hulbert
authors.affiliation: Division of Biostatistics.
authors.forename: Ling
authors.initials: L
authors.lastname: Chen
authors.affiliation: Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology.
authors.forename: Ari N
authors.initials: AN
authors.lastname: Berlin
authors.affiliation: Division of Pediatric Critical Care Medicine, Department of Pediatrics.
authors.forename: Ron
authors.initials: R
authors.lastname: Jackups
authors.affiliation: Washington University School of Medicine in St Louis, St Louis, Missouri.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Spinella
mesh_terms: D056586:Acute Chest Syndrome / Q000209:etiology*; D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000628:therapy*; D001793:Blood Preservation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors