Older Blood Safe as New Blood for Transfusions

Transfusions with fresh red blood cells are not any better than older red blood cells at reducing the risk of organ failure or death in critically ill children, a new study says.

The findings show that the standard practice of transfusions with older cells is just as safe and effective, according to the researchers.

Their study included more than 1,400 critically ill children, aged 3 days to 16 years, at 50 medical centers in the United States, Canada, France, Italy and Israel.

Half received transfusions with fresh red blood cells stored for less than seven days and half received transfusions with older red cells stored for 12 to 25 days.

Rates of new or progressive organ dysfunction were about 20% among those who received fresh red cells and about 18% among those who received older red cells. Death rates were similar in both groups.

The study, partly funded by the U.S. National Heart, Lung, and Blood Institute (NHLBI), was published online Dec. 10 in the Journal of the American Medical Association.

"Our findings indicate that doctors should not be afraid to use older red cells in critically ill children," said study co-principal investigator Dr. Philip Spinella, a researcher with the Pediatric Critical Care Translational Research Program at Washington University School of Medicine in St. Louis.

"Those who are showing a preference for fresh red cells might consider discontinuing this practice unless there are extenuating circumstances," he added in an NHLBI news release.

The findings also offer good news for blood banks, which will likely feel less pressure to respond to requests for fresh red cells, according to Spinella.

Red blood cell transfusions are commonly given to critically ill children with conditions such as trauma, cancer chemotherapy, bleeding during surgery, and chronic conditions such as sickle cell disease and thalassemia.

Transfusing the oldest red cells in their inventory first is standard practice at many hospitals, but some hospitals strive to provide fresh red blood cells to critically ill children, despite a lack of evidence supporting that practice.

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