Transfusion of older stored blood and risk of death: a meta-analysis

Authors

  • Dong Wang,

    Corresponding author
    1. From the Critical Care Medicine Department and the Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland; and the Anesthesia and Critical Care Medicine Department, West China Hospital of Sichuan University, Cheng Du, China.
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  • Junfeng Sun,

    1. From the Critical Care Medicine Department and the Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland; and the Anesthesia and Critical Care Medicine Department, West China Hospital of Sichuan University, Cheng Du, China.
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  • Steven B. Solomon,

    1. From the Critical Care Medicine Department and the Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland; and the Anesthesia and Critical Care Medicine Department, West China Hospital of Sichuan University, Cheng Du, China.
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  • Harvey G. Klein,

    1. From the Critical Care Medicine Department and the Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland; and the Anesthesia and Critical Care Medicine Department, West China Hospital of Sichuan University, Cheng Du, China.
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  • Charles Natanson

    1. From the Critical Care Medicine Department and the Department of Transfusion Medicine, National Institutes of Health, Bethesda, Maryland; and the Anesthesia and Critical Care Medicine Department, West China Hospital of Sichuan University, Cheng Du, China.
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  • The content of this publication does not necessarily represent the views or policies of the National Institutes of Health, the Department of Health and Human Resources, or the US Federal Government.

Dong Wang, Critical Care Medicine Department, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Building 10, Room 2C145, Bethesda, MD 20892; e-mail: wangd4@cc.nih.gov.

Abstract

BACKGROUND: Blood for transfusion is stored for up to 42 days. Older blood develops lesions and accumulates potentially injurious substances. Some studies report increasing toxicity as blood ages. We assessed the safety of transfused older versus newer stored blood.

STUDY DESIGN AND METHODS: PubMed, Scopus, and Embase were searched using terms new and old and red blood cell and storage through May 6, 2011, for observational and randomized controlled studies comparing outcomes using transfused blood having longer and shorter storage times. Death was the outcome of interest.

RESULTS: Twenty-one studies were identified, predominantly in cardiac surgery (n = 6) and trauma (n = 6) patients, including 409,966 patients. A test for heterogeneity of these studies' results was not significant for mortality (I2 = 3.7%, p = 0.41). Older blood was associated with a significantly increased risk of death (odds ratio, 1.16; 95% confidence interval [CI], 1.07-1.24). Using available mortality data, 97 (95% CI, 63-199) patients need to be treated with only new blood to save one life. Subgroup analysis of these trials indicated that the increased risk was not restricted to a particular type of patient, size of trial, or amount of blood transfused.

CONCLUSION: Based on available data, use of older stored blood is associated with a significantly increased risk of death.

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