Presently, when red blood cell transfusion is required, blood banks transfuse the oldest unit available. In North America that means red cells stored up to 42 days may be transfused to critically ill children despite some concern that older blood may have negative effects. There is also a widely held belief that the freshest red cells possible may benefit more vulnerable patients. Therefore, some critically ill children are routinely transfused fresh red cells without evidence that this is best practice. If fresh red cell units are better, then fresh blood should be provided to all critically ill children. On the other hand, if fresh blood is shown to be no different or harmful, then those who offer fresh red cells to certain critically ill children should stop doing so given extra costs and potential ethical concerns associated with inequitable use of a scarce resource. Critically ill patients often develop a disorder called multiple organ dysfunction syndrome (MODS) which can affect all their organs (heart, lungs, brain, etc); as more organs are affected the likelihood of death increases. Based on the premise that transfusion of older blood might worsen organ failure, this study plans to assess the effect of transfusion on the gravity of organ failure in 1538 critically ill children admitted to pediatric intensive care units. We will compare a group receiving standard issue red cell units (which are older) to a group receiving fresher red cells (stored for 7 days or less). Negative findings (no difference) will reassure clinicians and blood bankers as well as patients regarding the safety of the present delivery systems. Positive findings (fresher red cells decrease MODS) will confirm that prolonged storage has clinical consequences, would modify transfusion policies so that fresher red cells are transfused in critically ill children and would challenge the transfusion community to develop methods to mitigate the negative effects of prolonged red cell storage.
Gauvin F, Spinella P, Lacroix J, Choker G, Toledano B, Hébert PC, Tucci M on behalf of the Canadian Critical Care Trials Group and the Pediatric Acute Lung Injury and Sepsis Investigators Network. Association between length of red blood cell storage and multiple organ dysfunction syndrome in pediatric intensive care. Transfusion 2010; 50:1902-1913.
Karam O, Tucci M, Bateman ST, Ducruet T, Spinella PC, Randolph AG, Lacroix J for the PALISI Network. Association between length of storage of red blood cell units and outcome of critically ill children. Critical Care 2010, Apr 8;14(2):R57.
Philip Spinella, Jacques Lacroix, Kusum Menon, Paul Hébert, Dean Fergusson, Alan Tinmouth, Heather Hume, Alexis Turgeon, Jaime Caro, Chris Silliman, Robert A Berg, Cassandra Josephson, Marie Steiner, Steven Sloan, Allan Doctor