Fresh red blood cell transfusion and short-term pulmonary, immunologic, and coagulation status: a randomized clinical trial

Abstract

Rationale: 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.

Objectives: 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.

Methods: 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.

Measurements and main results: 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.

Conclusions: 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).

Figures

Figure 1.

Study participation flow diagram. Hgb = hemoglobin; RBC = red blood cells.

Figure 2.

Changes in markers of pulmonary function among those receiving fresh versus standard issue RBC transfusion. PaO2/FiO2 = ratio of partial pressure of arterial oxygen to fraction of inspired oxygen; RBC = red blood cells; Vd/Vt = ratio of dead space volume to tidal volume. Summary statistics and P values for the hypothesis tests performed are presented in Table 3.

Figure 3.

Changes in markers of immune and coagulation status among those receiving fresh versus standard issue RBC transfusion. ATC = antithrombin consumption; RBC = red blood cell; TNF = tumor necrosis factor. Summary statistics and P values for the hypothesis tests performed are presented in Table 3.