Transfusion medicine

Age of red blood cells may not matter: TRANSFUSE

The transfusion of older stored red blood cells is safe and, unexpectedly, associated with fewer side effects than transfusion with fresher blood cells an Australian study has found, putting the question of whether ‘fresher is better’ to rest.

The TRANSFUSE trial published in the NEJM showed that fresher blood offered no additional mortality benefit to critically ill patients at 90 days over older blood.

Researchers from the Australian and New Zealand Intensive Care Research Centre at Monash University in Melbourne who led the international trial also found older blood was associated with fewer transfusion reactions, including fever and in the most severely ill patients, the transfusion of older blood was associated with fewer deaths.

According to the authors led by Professor of intensive care medicine Dr James Cooper, the findings provide ‘strong evidence’ that the current recommended duration of storage of red blood cells for transfusion of 45 days is both safe and optimal, as is the standard practice of transfusing patients with the oldest red cells available.

TRANSFUSE compared the effect of using the freshest and oldest available red cells in 4,919 high-risk critically ill patients.

Researchers randomly assigned 2,457 patients to a short-term storage group and 2,462 patients to a long-term storage group.

Patients who received allogeneic red cells stored for a longer duration had comparable 90-day mortality rates as adults who received the freshest cells.

There were no statistically significant differences in 28-day mortality, rates of persistent organ dysfunction or death at 28 days, new bloodstream infections, mechanical ventilation, renal-replacement therapy or ICU length of stay.

The investigators did report that more patients in the short-term group experienced febrile non-haemolytic transfusion reactions, but the difference lost significance after adjustment.

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