Fresh Red Blood Cell Transfusion and Short-Term Pulmonary, Immunologic, and Coagulation Status: A Randomized Clinical Trial

• Published in: American journal of respiratory and critical care medicine Vol. 185; no. 8; pp. 842 - 850
• Main Authors: KOR, Daryl J, KASHYAP, Rahul, WEISKOPF, Richard B, WILSON, Gregory A, BUSKIRK, Camille M. Van, WINTERS, Jeffrey L, MALINCHOC, Michael, HUBMAYR, Rolf D, GAJIC, Ognjen
• Format: Journal Article
• Language: English
• Published: New York, NY American Thoracic Society 15.04.2012
• Subjects: Academic Medical Centers; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Biomarkers - blood; Blood Banks; Blood Coagulation Disorders - epidemiology; Blood Coagulation Disorders - etiology; Blood Preservation - adverse effects; Blood Preservation - methods; Blood products; Blood Safety; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Clinical trials; Critical Illness - mortality; Critical Illness - therapy; Double-Blind Method; Electronic health records; Erythrocyte Transfusion - adverse effects; Erythrocyte Transfusion - methods; Female; Humans; Intensive care medicine; Intensive Care Units; Intubation, Intratracheal; Leukocytes; Lung Diseases - etiology; Lung Diseases - physiopathology; Male; Medical records; Medical sciences; Middle Aged; Mortality; Patients; Pulmonary Gas Exchange; Reference Values; Respiration, Artificial; Risk Assessment; Survival Rate; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Treatment Outcome; Short term; clinical trial; Blood cell; Intensive care; Transfusion; Immunomodulation; Fresh blood; Red blood cell; critical care; Respiratory system; Resuscitation
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.201107-1332OC

Transfusion-related pulmonary complications are leading causes of morbidity and mortality attributed to transfusion. Observational studies suggest an important role for red blood cell (RBC) storage duration in these adverse outcomes. To evaluate the impact of RBC storage duration on short-term pulmonary function as well as immunologic and coagulation status in mechanically ventilated patients receiving RBC transfusion. This is a double-blind, randomized, clinical trial comparing fresh (≤5 d of storage) versus standard issue single-unit RBC transfusion in adult intubated and mechanically ventilated patients. The primary outcome is the change in pulmonary gas exchange as assessed by the partial pressure of arterial oxygen to fraction of inspired oxygen concentration ratio (ΔPa(O(2))/Fi(O(2))). Secondary outcomes include changes in immune and coagulation status. Fifty patients were randomized to receive fresh RBCs and an additional 50 patients to standard issue RBCs. Median storage age was 4.0 days (interquartile range, 3.0-5.0) and 26.5 days (interquartile range, 21.0-36.0) in the fresh RBC group and standard issue RBC group, respectively. No differences were noted in the primary outcome of ΔPa(O(2))/Fi(O(2)) (difference between the mean ΔPa(O(2))/Fi(O(2)) in the standard issue RBC group vs. the fresh RBC group, -11.5; 95% confidence interval, -35.3 to 12.3; P = 0.22). Similarly, no significant differences were noted in markers of immunologic or coagulation status. In this randomized clinical trial, no differences were noted in early measures of pulmonary function or in immunologic or coagulation status when comparing fresh versus standard issue single-unit RBC transfusion. Clinical trial registered with ClinicalTrials.gov (NCT00751322).