Red blood cells for transfusion like a good red — a little older, a little better
A landmark Australian research trial has found the transfusion of older stored red blood cells is safe and surprisingly, associated with fewer side effects. In the TRANSFUSE trial, researchers from the Australian and New Zealand Intensive Care Research Centre at Monash University in Melbourne led teams in 5 countries to investigate the effect of the age of transfused red blood cells on critically ill patient's outcomes.
In a study published in the New England Journal of Medicine on September 27th, the team demonstrated that fresher blood was no better than older blood. Unexpectedly they also found fewer transfusion reactions, including fever, with the older blood; and in the most severely ill patients, the transfusion of older blood was associated with fewer deaths.
Lead researcher Professor Jamie Cooper said "older blood appears to be like a good red wine- better with some age. The findings of our trial confirm that the current duration of storage of red blood cells for transfusion is both safe and optimal".
In Australia, red blood cells are stored for up to 42 days before transfusion. Routine practice in most hospitals is to allocate the oldest available compatible blood. Concerns regarding changes in the red blood cells for transfusion during storage, have led some countries to reduce this to 35 days, and some doctors to request fresher blood for specific patients under the belief the "fresh must be best". "Such practices can significantly reduce the availability of blood for transfusion" said Professor Cooper. "Our study shows these practices are not required and are potentially counterproductive".
The TRANSFUSE trial was of 5000 Intensive Care patients in Australia, New Zealand, Finland, Ireland and Saudi Arabia. This ground-breaking research was performed in collaboration with the Australian and New Zealand Intensive Care Society Clinical Trials Group, and the Irish Critical Care-Clinical Trials Group. It was made possible by grants from the National Health and Medical Research Council, the Health Research Council of NZ, and the Health Research Board of Ireland. TRANSFUSE was supported by the Australian Red Cross Blood Service, the Australian National Blood Authority and the national blood transfusion services of New Zealand, Ireland, and Finland.