Association of transfusion red blood cell storage age and blood oxygenation, long-term neurologic outcome, and mortality in traumatic brain injury

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Abstract

The effect of red blood cell (RBC) storage on oxygenation in critically ill patients is still unknown. The objective of this study was to determine the association of RBC storage with oxygenation, long-term neurologic recovery, and death after traumatic brain injury.

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Duration of red blood cell storage is associated with increased incidence of deep vein thrombosis and in hospital mortality in patients with traumatic injuries

Philip Spinella, Christopher Carroll, Ilene Staff … (2009)

Introduction In critically ill patients the relationship between the storage age of red blood cells (RBCs) transfused and outcomes are controversial. To determine if duration of RBC storage is associated with adverse outcomes we studied critically ill trauma patients requiring transfusion. Methods This retrospective cohort study included patients with traumatic injuries transfused ≥5 RBC units. Patients transfused ≥ 1 unit of RBCs with a maximum storage age of up to 27 days were compared with those transfused 1 or more RBC units with a maximum storage age of ≥ 28 days. These study groups were also matched by RBC amount (+/- 1 unit) transfused. Primary outcomes were deep vein thrombosis and in-hospital mortality. Results Two hundred and two patients were studied with 101 in both decreased and increased RBC age groups. No differences in admission vital signs, laboratory values, use of DVT prophylaxis, blood products or Injury Severity Scores were measured between study groups. In the decreased compared with increased RBC storage age groups, deep vein thrombosis occurred in 16.7% vs 34.5%, (P = 0.006), and mortality was 13.9% vs 26.7%, (P = 0.02), respectively. Patients transfused RBCs of increased storage age had an independent association with mortality, OR (95% CI), 4.0 (1.34 - 11.61), (P = 0.01), and had an increased incidence of death from multi-organ failure compared with the decreased RBC age group, 16% vs 7%, respectively, (P = 0.037). Conclusions In trauma patients transfused ≥5 units of RBCs, transfusion of RBCs ≥ 28 days of storage may be associated with deep vein thrombosis and death from multi-organ failure.

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Transfusion of aged packed red blood cells results in decreased tissue oxygenation in critically injured trauma patients.

Laszlo Kiraly, Jonas Schreiber, S. Underwood … (2009)

Blood transfusion is a common event in the treatment of injured patients. The effect of red blood cell transfusion on tissue oxygenation is unclear. The transfusion of older blood has been shown to be detrimental in retrospective studies. This study aims to study the effect of the age of the blood transfused on the tissue oxygenation using near infrared spectroscopy. Thirty-two critically injured trauma patients for whom a blood transfusion had been ordered were recruited. Each patient had a transcutaneous probe placed on the thenar eminence. The probe was placed 1 hour before the transfusion and left in place until 4 hours after transfusion. Tissue oxygen saturation (Sto2) was recorded every 2 minutes. The Sto2 area under the curve (AUC) over time periods was calculated. A control group (n = 16), not transfused, was recruited. The transfusion group was divided into two groups by blood age. One group received blood less than 21 days old, (new blood, n = 15) and the other received blood 21 days old or greater (old blood, n = 17). The data were analyzed for significance with Kendall's W and Wilcoxon's signed rank test (p < 0.05). Baseline characteristics such were not significantly different between groups. The baseline AUC did not differ between groups. The old blood group demonstrated a significant decline in Sto2 comparing its baseline period to its transfusion period (p < 0.05). There was no similar decline in the control group or the new blood group. The posttransfusion period AUC for the old blood group was also lower versus baseline (p = 0.06). There was a moderate correlation between increasing age of blood and decrease in oxygenation (r = 0.5). There was a decrease in peripheral tissue oxygenation in patients receiving older red blood cells. There was no oxygenation decrease in patients receiving blood less than 21 days. This indicates that factors in stored blood may influence the peripheral vasculature and oxygen delivery.

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Impact of age of transfused blood on cerebral oxygenation in male patients with severe traumatic brain injury.

Rosario Amaya-Villar, Victoria Arellano-Orden, Carmen Ferrándiz-Millón … (2008)

Prolonged erythrocyte storage time might reduce the efficacy of transfusion. In this study, the effects of transfusion of erythrocytes with four different storage periods ( 19 days, n = 16 patients) on brain tissue oxygen tension (PtiO2) in stable male patients with severe traumatic brain injury were investigated during a 24-hr follow-up period. Prospective, observational study. Neurotrauma critical care unit of a university hospital. Sixty-six male, nonbleeding, hemodynamically stable anemic patients (hemoglobin 19 days. Transfusion of erythrocytes increased cerebral oxygenation in patients with severe traumatic brain injury, except in those transfused with erythrocytes stored >19 days.