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Haematologica 2018 Volume 103(9):1542-1548
1Critical Care Research Group, Faculty of Medicine, University of Queensland, Brisbane, Australia; 2Research and Development, Australian Red Cross Blood Service, Brisbane, Australia; 3School of Medicine and Population Health, The University of Newcastle, Callaghan, Australia; 4Centre for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands and 5Department of Clinical Epidemiology, Leiden University Medical Center, the Netherlands
Ferrata Storti Foundation
Blood Transfusion
Transfusion of packed red blood cells at the end of shelf life is associated with increased risk of mortality – a pooled patient data analysis of 16 observational trials
Monica S.Y. Ng,1,2 Michael David,3 Rutger A. Middelburg,4,5 Angela S.Y. Ng,1 Jacky Y. Suen,1 John-Paul Tung1,2 and John F. Fraser1
ABSTRACT
Observational studies address packed red blood cell effects at the end of shelf life and have larger sample sizes compared to ran- domized control trials. Meta-analyses combining data from observational studies have been complicated by differences in aggregate transfused packed red blood cell age and outcome reporting. This study abrogated these issues by taking a pooled patient data approach. Observational studies reporting packed red blood cell age and clinical outcomes were identified and patient-level data sets were sought from investigators. Odds ratios and 95% confidence intervals for binary out- comes were calculated for each study, with mean packed red blood cell age or maximum packed red blood cell age acting as independent vari- ables. The relationship between mean packed red blood cell age and hos- pital length of stay for each paper was analyzed using zero-inflated Poisson regression. Random effects models combined paper-level effect estimates. Extremes analyses were completed by comparing patients transfused with mean packed red blood cell aged less than ten days to those transfused with mean packed red blood cell aged at least 30 days. sixteen datasets were available for pooled patient data analysis. Mean packed red blood cell age of at least 30 days was associated with an increased risk of in-hospital mortality compared to mean packed red blood cell of less than ten days (odds ratio: 3.25, 95% confidence inter- val: 1.27-8.29). Packed red blood cell age was not correlated to increased risks of nosocomial infection or prolonged length of hospital stay.
Introduction
Packed red blood cells (PRBCs) have a shelf life of 21-49 days depending on the additive solution used and jurisdiction.1 During in vitro storage, PRBCs accumulate cellular and biochemical changes collectively called the red blood cell (RBC) stor- age lesion. These changes occur secondary to RBC metabolism under artificial conditions such as refrigeration temperatures, limited nutrient supply and absent clearance mechanisms. RBC storage lesions clearly disturb physiological mecha- nisms and lead to harm in in vitro tests and animal models.2,3 Clinical data linking PRBC storage duration to adverse outcomes, such as mortality, nosocomial infec- tion, prolonged hospital length of stay (HLOS), prolonged intensive care unit (ICU) length of stay, prolonged mechanical ventilation, acute renal failure and multiple organ dysfunction – have been consistently equivocal.2,4 The majority of studies demonstrating the damage caused by prolonged PRBC storage have been retrospective and observational in nature.5 Recent large randomized controlled tri- als (RCTs) have not linked PRBC storage duration to adverse outcomes.6-9 However, the two types of studies tended to ask different questions— the former, “Is prolonged PRBC storage harmful?” versus the latter, “Are fresh PRBCs better than standard practice?”. Furthermore, observational studies often had larger
Correspondence:
monica.ng91@gmail.com
Received: February 22, 2018. Accepted: May 21, 2018. Pre-published: May 24, 2018.
doi:10.3324/haematol.2018.191932
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/103/9/1542
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