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Fresh red blood cell transfusions do not help critically ill children more than older cells
Researchers have found that transfusions using fresh red blood cells—cells that have spent seven days or less in storage—are no more beneficial than older red blood cells in reducing the risk of organ failure or death in critically ill children. The findings, the researchers said, should reassure doctors that the standard practice of using older red cells is just as safe and effective in these children, who are among the sickest and most fragile of patients.
Person donating blood. Photo: LuAnn Hunt/Unsplash
The study, one of the largest clinical trials to investigate red blood cell storage in critically ill children, sheds light on a controversial aspect of transfusion medicine that has been understudied.
“Our findings indicate that doctors should not be afraid to use older red cells in critically ill children,” said study co-principal investigator Philip Spinella, M.D., a researcher with the Pediatric Critical Care Translational Research Program at Washington University School of Medicine in St. Louis.
“Those who are showing a preference for fresh red cells might consider discontinuing this practice unless there are extenuating circumstances.” Spinella added that the findings also provide good news for blood banks, which he said will likely feel less pressure to respond to requests for fresh red cells.
Red blood cell transfusions are commonly given to critically ill children for conditions such as trauma, cancer chemotherapy, intraoperative bleeding, and chronic conditions such as sickle cell disease and thalassemia.
Transfusing the oldest red cells in the stored inventory first is standard practice among many hospitals. However, some hospitals preferentially give fresh red blood cells to critically ill children, even though clinical studies supporting the benefits of this practice have been lacking.
To help fill the research gap, scientists conducted the Age of Blood in Children in Pediatric Intensive Care Units (ABC-PICU) randomized trial at 50 medical centers between February 2014 and November 2018. They recruited critically ill patients from pediatric intensive care units in the United States, Canada, France, Italy, and Israel.
The researchers found that fresh red cells did not reduce the incidence of new or progressive multiple organ dysfunction or death compared to older red cells and that the outcomes were not significantly different between the two groups.
About 20.2% of those who received fresh red cells experienced new or progressive organ dysfunction while 18.2% of those who received older red cells experienced similar dysfunction.
The researchers did note some caveats. The study did not examine whether the use of the oldest red cells allowable (35-42 days old) affects outcomes, or if fresh red cells affect outcomes for children requiring large-volume red cell transfusions. The children in this study received low-volume red cell transfusions. (National Institutes of Health)
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