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Duration of red blood cell storage and survival of transfused patients (CME)

Authors

  • Gustaf Edgren,

    1. From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
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  • Mads Kamper-Jørgensen,

    1. From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
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  • Sandra Eloranta,

    1. From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
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  • Klaus Rostgaard,

    1. From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
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  • Brian Custer,

    1. From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
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  • Henrik Ullum,

    1. From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
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  • Edward L. Murphy,

    1. From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
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  • Michael P. Busch,

    1. From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
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  • Marie Reilly,

    1. From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
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  • Mads Melbye,

    1. From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
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  • Henrik Hjalgrim,

    1. From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
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  • And Olof Nyrén

    1. From the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Epidemiology Research, Statens Serum Institut, and the Department of Clinical Immunology, Center of Clinical Investigation, Copenhagen University Hospital, Copenhagen, Denmark; the Blood Systems Research Institute and the Department of Laboratory Medicine, University of California, San Francisco, California; and the Pharmaceuticals Outcomes Research and Policy Program, University of Washington, Seattle, Washington.
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Errata

This article is corrected by:

  1. Errata: CORRECTION Volume 50, Issue 8, 1857, Article first published online: 2 August 2010
  2. Errata: Article first published online:

  • This study was funded by the National Heart, Lung, and Blood Institute of the U.S. National Institutes of Health (N01-HB-47174). The creation of the SCANDAT database was funded by the National Heart, Lung, and Blood Institute and the National Cancer Institute of the U.S. National Institutes of Health (N01-CP-21175). GE has received funding through a postdoctoral stipend from Svenska Sällskapet för Medicinsk Forskning (SSMF). MKJ and HH have received funding from the Danish Medical Research Council (271-08-0831). ELM has received a career development award (K24-HL-75036) from the U.S. National Heart, Lung, and Blood Institute. The funding organization did not participate in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Dr Gustaf Edgren, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, SE-171 77, Stockholm, Sweden; e-mail: gustaf.edgren@ki.se.

Abstract

BACKGROUND: Disquieting reports of increased complication and death rates after transfusions of red blood cells (RBCs) stored for more than 14 days prompted us to perform an observational retrospective cohort study of mortality in relation to storage time.

STUDY DESIGN AND METHODS: We conducted a cohort study utilizing data on all recipients of at least one RBC transfusion in Sweden and Denmark between 1995 and 2002, as recorded in the Scandinavian Donations and Transfusions (SCANDAT) database. Relative risks of death in relation to storage time were estimated using Cox regression, adjusted for several possible confounding factors.

RESULTS: After various exclusions, 404,959 transfusion episodes remained for analysis. The 7-day risk of death was similar in all exposure groups, but a tendency for a higher risk emerged among recipients of blood stored for 30 to 42 days (hazard ratio, 1.05; 95% confidence interval [CI], 0.97-1.12), compared to recipients of blood stored for 10 to 19 days. With 2-year follow-up, this excess remained at the same level (hazard ratio, 1.05; 95% CI, 1.02-1.08). No dose-response pattern was revealed and no differential effect was seen when the analyses were restricted to recipients of leukoreduced units only.

CONCLUSION: Although a small excess mortality was noted in recipients of the oldest RBCs, the risk pattern was more consistent with weak confounding than with an effect of the momentary exposure to stored RBCs. It seems, thus, that any excess mortality conferred by older RBCs in the combined Swedish and Danish transfusion recipient population is likely less than 5%, which is considerably smaller than in the hitherto largest investigation.

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