New evidence shows red blood cell units stored 21 to 42 days have similar clinical effects in cardiac surgery patients compared to units stored up to 10 days.
The findings of the study, called the Red Cell Storage duration Study (RECESS), are published in New England Journal of Medicine.
The FDA allows red blood cell (RBC) units to be stored for up to 42 days after blood donation. At most hospitals, standard transfusion practice is to utilize RBC units that are closest to 42 days old, so that the donated units will not reach their expiration date and be wasted. RECESS sought to compare clinical outcomes in cardiac surgery patients who received RBC units stored up to 10 days and patients who received RBC units stored 21 to 42 days.
“Some observational studies indicated serious, potentially deadly, adverse events in transfusions using RBC units stored more than a few weeks,” said Marie Steiner, M.D., M.S., principle investigator and a pediatric hematologist and professor at the University of Minnesota Medical School. “However, because those studies were not randomized, the groups getting longer-storage RBC units and shorter-storage RBC units sometimes differed on important patient and surgery characteristics, making it difficult to do a fair comparison. We wanted to take a more controlled look at the issue. RECESS is the first large randomized, controlled trial in cardiac surgery patients to address these previous study limitations.”
Steiner and her colleagues enrolled patients between 2010 and 2014, analyzing 1098 participants. The participants in the study were at least 12 years of age, undergoing complex cardiac surgery and requiring RBC transfusions. Participants were randomized, with one group getting RBC units stored 10 days or less and the other receiving RBC units stored 21 days or longer.
The primary outcome measured was the change in the Multiple Organ Dysfunction Score, an objective scale tabulating the extent of dysfunction of individual organ systems, from before surgery through day 7, hospital discharge or death. Researchers found no significant difference between the two groups for Multiple Organ Dysfunction Score through 7 or 28 days, mortality rates, or the number of serious and non-serious adverse events.
“We concluded there is no evidence to support the practice of preferentially transfusing red blood cells stored less than 10 days to complex cardiac surgery patients who are at least 12 years old,” said Steiner. “This study was made possible through incredible teamwork between cardiac surgery, intensive care and transfusion medicine personnel, and it resulted in a clear answer that shorter-storage RBC units are not necessary for these patients.”
In addition to RECESS, the ABLE study was published in the same issue of the New England Journal of Medicine. The ABLE study enrolled critically ill adults who were randomized to receive RBCs stored less than seven days or standard issue RBCs. Similar to RECESS, ABLE found no difference in their primary outcome, mortality, between the study arms. These studies should be reassuring that transfusing “fresher blood” is not likely to improve clinical outcomes in these critically ill populations.
RECESS was funded by the National Heart, Lung and Blood Institute and the National Institutes of Health. The project was performed in partnership with the New England Research Institutes.
The post New research shows no advantage to shorter-storage red blood cell transfusions for cardiac surgery patients appeared first on Health Talk.