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Fresh red blood cells add no advantages for critically ill

Key clinical point: Fresh red blood cells didn’t provide any additional gains in outcomes or reduce mortality at 90 days.

Major finding: The survival analysis of the time to death showed a hazard ratio of those in the fresh-blood group was 1.1, compared to those in the standard blood group (95% confidence interval, 0.9-1.2) (P = .38).

Data source: A multicenter, blinded, randomized prospective study in 2,430 patients receiving red blood cell transfusions.

Disclosures: The study was supported by the Canadian Institutes of Health Research, Fonds de Recherche du Québec–Santé, the National Institute for Health Research Evaluation, the French Ministry of Health, and the Etablissement Français du Sang, and Sanquin Blood Supply. Two authors reported grants and personal fees from pharmaceutical companies outside the submitted work, while others reported financial support from the study funding sources.


 

References

The use of fresh red blood cells for transfusion did not reduce mortality or improve other outcomes, compared with older standard-issue red cells, according to results of a multicenter, blinded, randomized prospective study presented at the annual meeting of the International Society on Intensive Care and Emergency Medicine.

In the Age of Blood Evaluation (ABLE) study, researchers randomized 1,211 critically ill patients to red blood cells stored for less than 8 days and 1,219 patients to standard-issue cells stored for a mean of 22.4 days. The study was conducted at 64 centers in Europe and Canada, where all blood units were leukoreduced and SAGM (saline-adenine-glucose-mannitol) suspended. Similar products are supplied in the United States, but red cells are suspended in additive solution 3 (AS3) rather than SAGM.

Compared with older standard-issue red cells, fresh red blood cells for transfusion did not reduce mortality or improve other outcomes. ©Vlad/Fotolia.com

Compared with older standard-issue red cells, fresh red blood cells for transfusion did not reduce mortality or improve other outcomes.

At 90 days, 37% of patients in the fresh-blood group and 35.3% of patients in the standard blood group had died. The survival analysis of the time to death showed a hazard ratio of those in the fresh-blood group was 1.1, compared with those in the standard blood group (95% confidence interval, 0.9-1.2; P = .38).

There were no significant differences in the rates of death, organ failure, acute respiratory distress, cardiovascular complications, thrombosis, infection, or acute transfusion reaction.

There also were no significant differences between the two groups in length of hospital stay or duration of supportive care such as mechanical ventilation, as was simultaneously reported in the March 17 edition of the New England Journal of Medicine (doi:10.1056/NEJMoa1500704).

“Although [other] initial studies showed an association between longer red-cell storage and adverse outcomes, these associations may have been spurious owing to sicker patients receiving more units with longer storage, the overlap between comparison groups in the age of the red cells transfused, and the inclusion of transfusions that occurred after the clinical events,” Dr. Jacque Lacroix of University of Montreal and his coauthors wrote.

The study was supported by the Canadian Institutes of Health Research, Fonds de Recherche du Québec–Santé, the National Institute for Health Research Evaluation, the French Ministry of Health, and the Etablissement Français du Sang, and Sanquin Blood Supply. Two authors reported grants and personal fees from pharmaceutical companies outside the submitted work, while others reported financial support from the study funding sources.

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