Clinical Outcomes and Red Blood Cell Storage

Transfusions remain a cornerstone of medical therapy in the critically ill patient, with at least 30% of patients in the ICU receiving one or more red blood cell transfusions (Shehata et al. Transfusion 54:2631-9, 2014; Vincent, JAMA 288:1499-507, 2002; Corwin, Crit Care Med 32:39-52, 2004). Our understanding of the biochemical, structural, and functional changes that occurs to red blood cells with storage – also known as the storage lesion – has fueled concerns around transfusion of stored blood. To date, 16 randomized controlled trials across various clinical settings in both the pediatric and adult literature have established that transfusion of red blood cells stored for shorter durations does not reduce the risk of recipient mortality. These studies have also shown that transfusion of long-term stored blood (stored for 36–42 days) is not harmful, and thus, current practice remains appropriate. Interestingly, randomized trials may have raised questions around the safety of “fresh” blood. Building on this body of work, an emerging area of research explores the potential clinical impacts of blood donor age and sex as well as the method of whole blood processing on recipient outcomes.