Use of fresh red blood cells for transfusions for premature infants does not improve outcomes

Among premature, very low-birth-weight infants requiring a transfusion, use of fresh red blood cells (RBCs) compared with standard RBC transfusion practice did not improve clinical outcomes that included rates of complications or death, according to a study in the October 10 issue of JAMA. The study is being published early online to coincide with its presentation at the AABB (formerly the American Association of Blood Banks) Annual Meeting.

"Although RBC transfusions are used routinely in acutely ill patients, including those in units, the clinical consequences of the prolonged storage of RBCs have not been firmly established," according to background information in the article. "In recent years, several conducted primarily in adults have demonstrated that prolonged RBC storage is associated with increased rates of infection, , death, and increased lengths of stay."

Dean A. Fergusson, M.H.A., Ph.D., of the Ottawa Hospital Research Institute, Ottawa, Canada and colleagues conducted a study to evaluate whether RBCs stored for 7 days or less decreased serious neonatal illness and death compared with standard blood bank issue. The included 377 premature infants with birth weights less than 2.8 lbs. (1,250 grams) admitted to 6 Canadian neonatal units between May 2006 and June 2011. Patients were randomly assigned to receive transfusion of RBCs stored 7 days or less (n = 188) vs. standard-issue RBCs in accordance with standard blood bank practice (n = 189). The primary outcome for the study was a composite measure of major neonatal illnesses, as well as death. The primary outcome was measured within the entire period of neonatal stay up to 90 days after randomization. The rate of hospital-acquired (nosocomial) infection was a secondary outcome.

The average age of blood in the fresh RBC group was 5.1 days, compared with 14.6 in the standard RBC group. The average and median (midpoint) volumes transfused were similar in both groups, as were postrandomization cointerventions including modes of ventilation, insertion of lines and catheters, other blood products, and major surgical and diagnostic procedures.

A total of 199 infants (53.0 percent) experienced the composite primary outcome. The researchers found that among infants in the fresh RBC group, 99 (52.7 percent) had the primary outcome compared with 100 (52.9 percent) in the standard RBC group. "The rate of clinically suspected infection in the fresh RBC group was 77.7 percent (n = 146) vs. 77.2 percent (n = 146) in the standard RBC group. Rates of confirmed infections were 67.5 percent (n = 127) in the fresh RBC group vs. 64.0 percent (n = 121) in the standard RBC group. Among confirmed cases, rates of bacterial, fungal, and viral infections were similar between the 2 groups. Major sequelae of infections including rates of pneumonia, meningitis and osteomyelitis [inflammation of bone or bone marrow, usually due to infection] were also similar. The median (midpoint) length of stay was 77 days in the standard RBC group and 84 days in the fresh RBC group."

"We did not find any clinically meaningful or statistically significant differences and, therefore, the many laboratory changes that occur with prolonged RBC storage may not be as important as once thought," the authors write.

"In conclusion, the transfusion of fresh RBCs did not improve clinical outcomes in high-risk, premature, very low-birth-weight infants. We thus do not recommend any changes to storage time practices for the provision of RBCs to infants admitted to neonatal intensive care."

More information: JAMA. 2012;308[14]:1443-1451. The article is titled "Effects of Fresh Red Blood Cell Transfusions on Clinical Outcomes in Premature, Very Low-Birth-Weight Infants" and was published online by the Journal of the American Medical Association on Oct. 8, 2012.

add to favorites email to friend print save as pdf

Related Stories

Old red blood cells may double mortality in trauma patients

Sep 22, 2009

Severe trauma patients requiring a major transfusion are twice as likely to die if they receive red blood cells stored for a month or longer, according to research published in BioMed Central's open access journal Critical Ca ...

A new way to boost red blood cell numbers

Jan 10, 2008

A common treatment for anemia — a deficiency in red blood cells (rbcs) caused by their insufficient production, excessive destruction, or excessive loss — is administration of recombinant erythropoietin (Epo), a hormone ...

Keeping up with demand for red blood cells

Jul 16, 2012

(Medical Xpress) -- Two cellular proteins team up to provide a steady supply of red blood cells (RBCs), according to a study by Lizhao Wu, PhD, of the University of Medicine and Dentistry of New Jersey-New Jersey Medical ...

Recommended for you

Humiliation tops list of mistreatment toward med students

1 hour ago

Each year thousands of students enroll in medical schools across the country. But just how many feel they've been disrespected, publicly humiliated, ridiculed or even harassed by their superiors at some point during their ...

Surrogate offers clues into man with 16 babies

10 hours ago

When the young Thai woman saw an online ad seeking surrogate mothers, it seemed like a life-altering deal: $10,000 to help a foreign couple that wanted a child but couldn't conceive.

Nurses go on strike in Ebola-hit Liberia

10 hours ago

Nurses at Liberia's largest hospital went on strike on Monday, demanding better pay and equipment to protect them against a deadly Ebola epidemic which has killed hundreds in the west African nation.

ALS Ice Bucket Challenge arrives in North Korea

Aug 31, 2014

It's pretty hard to find a novel way to do the ALS Ice Bucket Challenge by now, but two-time Grammy-winning rapper Pras Michel, a founding member of the Fugees, has done it—getting his dousing in the center ...

Cold cash just keeps washing in from ALS challenge

Aug 28, 2014

In the couple of hours it took an official from the ALS Association to return a reporter's call for comment, the group's ubiquitous "ice bucket challenge" had brought in a few million more dollars.

User comments