Transfusions of 'old' blood may harm some patients

January 9, 2017, Columbia University Medical Center

The oldest blood available for transfusions releases large and potentially harmful amounts of iron into patients' bloodstreams, a new study by researchers at Columbia University Medical Center (CUMC) has found.

Based on the new findings, the researchers recommend that the FDA reduce the maximum storage limit of from 6 weeks to 5 weeks, as long as there are sufficient blood supplies available.

"Our recommendation will be controversial, but we think we have real data to support it," said the study's co-leader Steven Spitalnik, MD, professor of pathology & at CUMC and medical director of the clinical laboratories at NewYork-Presbyterian/Columbia. "Recent studies have concluded that transfusing old blood has no impact on patient outcomes, but those studies didn't exclusively examine the oldest blood available for transfusions. Our new study found a real problem when transfusing blood that's older than 5 weeks."

Their findings appear in the January issue of the Journal of Clinical Investigation.

Transfusion of red blood cells is the most common procedure performed in hospitalized patients, with approximately 5 million patients receiving red blood cell transfusions annually in the United States. "But the longer you store blood, the more the cells become damaged," said the study's co-leader Eldad Hod, MD, associate professor of pathology & cell biology at CUMC and clinical pathologist at NewYork-Presbyterian/Columbia. Currently, the U.S. FDA allows units of red blood cells to be stored for up to 6 weeks before they must be discarded.

In the study, the researchers randomly assigned a group of 60 healthy volunteers to receive a unit of red that had been stored for 1, 2, 3, 4, 5, or 6 weeks. The volunteers were then monitored for 20 hours after transfusion.

Within hours after transfusion, 7 of the 9 volunteers who received the 6-week-old blood could not appropriately metabolize the damaged cells, thereby releasing large amounts of iron into their bloodstream. Only one volunteer who received younger blood had a similar response, with blood had been stored for five weeks.

None of the volunteers were harmed by the transfusion, but previous studies have shown that excess iron can enhance blood clots and promote infections. "Based on the amount of iron circulating in the blood of the volunteers who received 6-week-old blood, we'd predict that certain existing infections could be exacerbated," said Dr. Hod.

"Thus, for ill, hospitalized patients, this excess iron could lead to serious complications," said Dr. Spitalnik says.

The true impact of 6-week-old blood on the rate of complications in patients is likely to be small, the researchers say, but since millions of Americans receive transfusions each year, even a 1 percent difference in complications could affect a large number of patients.

"It's estimated that up to 10 to 20 percent of blood units used for transfusions have been stored for more than 5 weeks, so the number of patients who are likely to receive a unit of very old blood is substantial," Dr. Hod added.

"Based on our findings of potential harm, we think the prudent thing to do at this time is for the FDA to reduce the maximum storage period," said Dr. Spitalnik. "The U.K., Ireland, the Netherlands, and the National Institutes of Health have limited storage to 35 days, and we think that can be achieved throughout the U.S. without seriously affecting the supply."

The study is titled, "Prolonged red cell storage before transfusion increases extravascular hemolysis."

Explore further: International study proves old blood is as good as new

More information: Francesca Rapido et al, Prolonged red cell storage before transfusion increases extravascular hemolysis, Journal of Clinical Investigation (2016). DOI: 10.1172/JCI90837

Related Stories

International study proves old blood is as good as new

October 24, 2016
It's been long thought that when blood transfusions are needed, it may be best to use the freshest blood, but McMaster University researchers have led a large international study proving that it is not so.

Pretreating red blood cells with nitric oxide may reduce side effect linked to transfusions

November 7, 2016
A new treatment may diminish a dangerous side effect associated with transfusions of red blood cells (RBCs) known as pulmonary hypertension, an elevated blood pressure in the lungs and heart that can lead to heart failure, ...

Expert panel issues updated guidelines for red blood cell storage time and transfusion use

October 12, 2016
For most stable hospitalized patients, transfusions of red blood cells stored for any time point within their licensed dating period—so-called standard issue—are as safe as transfusions with blood stored 10 days or less, ...

Effect of duration of storage of red blood cells transfused for cardiac surgery

October 20, 2015
Although some studies have suggested that transfusion of stored red blood cell (RBC) concentrates may be harmful, as blood undergoes several physiological changes during storage, an analysis of patients who underwent cardiac ...

No association between sex-discordant blood transfusions and risk of death

November 22, 2016
New research from Karolinska Institutet refutes the findings of a previous study indicating a possible higher risk of death after sex-discordant blood transfusions for cardiac surgery.

Recommended for you

Drug may help surgical patients stop opioids sooner

December 13, 2017
(HealthDay)—Opioid painkillers after surgery can be the first step toward addiction for some patients. But a common drug might cut the amount of narcotics that patients need, a new study finds.

Children best placed to explain facts of surgery to patients, say experts

December 13, 2017
Getting children to design patient information leaflets may improve patient understanding before they have surgery, finds an article in the Christmas issue of The BMJ.

Burn victim saved by skin grafts from identical twin (Update)

November 23, 2017
A man doomed to die after suffering burns across 95 percent of his body was saved by skin transplants from his identical twin in a world-first operation, French doctors said Thursday.

Is a common shoulder surgery useless?

November 21, 2017
(HealthDay)—New research casts doubt on the true effectiveness of a common type of surgery used to ease shoulder pain.

Study shows electric bandages can fight biofilm infection, antimicrobial resistance

November 6, 2017
Researchers at The Ohio State University Wexner Medical Center have shown - for the first time - that special bandages using weak electric fields to disrupt bacterial biofilm infection can prevent infections, combat antibiotic ...

Obesity increases incidence, severity, costs of knee dislocations

November 3, 2017
A new study of more than 19,000 knee dislocation cases in the U.S. between 2000 and 2012 provides a painful indication of how the nation's obesity epidemic is changing the risk, severity and cost of a traumatic injury.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.