Table 2 Overview of the studies reporting the age of transfused red blood cells (RBCs) and patient outcomes.
First author | Year | Year(s) of enrollment | Design | Country/continent | Leuko-reduction | Setting | Number of patients transfused | Summary of main results |
|---|---|---|---|---|---|---|---|---|
Studies addressing mortality | ||||||||
Purdy et al. [42] | 1997 | 1992 | Retrospective single-center | Canada | NR | ICU septic | 31 | Non-survivors received a greater proportion of older RBCs |
Mynster et al. [53] | 2001 | 1991-1993 | Retrospective multicenter | Europe | No | Cancer | 740 | Mortality not different between patients transfused with RBCs aged more or less than 21 days |
Murrell et al. [48] | 2005 | 2001-2003 | Retrospective single-center | USA | Mix (95% LR) | Trauma | 275 | No correlation between 'dose of aged blood' and hospital mortality |
van de Watering et al. [38] | 2006 | 1993-1999 | Retrospective single-center | Europe | No | Cardiac surgery | 2,732 | No correlation between storage time variables and 30-day mortality |
Koch et al. [32] | 2008 | 1998-2006 | Retrospective single-center | USA | Mix | Cardiac surgery | 6,002 | Higher hospital and one-year mortality rate in older blood group |
Yap et al. [41] | 2008 | 2001-2007 | Retrospective single-center | Australia | Mix (3.8% LR) | Cardiac surgery | 670 | No association between storage duration and mortality |
Dessertaine et al. [43] | 2008 | 2005-2006 | Retrospective single-center | Europe | Yes | ICU | 534 | No association between the age of transfused red cells and mortality |
Weinberg et al. [44] | 2008 | 2000-2007 | Retrospective single-center | USA | Yes | Trauma | 1,813 | Transfusion of large (but not small) volumes of older blood associated with an increased risk of death |
Weinberg et al. [46] | 2008 | 2000-2007 | Retrospective single-center | USA | Yes | Trauma | 430 | Slightly increased mortality with transfusion of older blood (> 14 days old) |
Spinella et al. [47] | 2009 | 2004-2007 | Retrospective single-center | USA | Mix | Trauma | 202 | Hospital mortality higher for patients transfused with older RBCs; increased storage time independently associated with mortality |
Edgren et al. [30] | 2010 | 1995-2002 | Retrospective multicenter | Europe | Mix | Mix | 364,037 | 5% increased mortality after two years of follow-up |
Weinberg et al. [45] | 2010 | 2000-2009 | Retrospective single-center | USA | Yes | Trauma | 1,647 | Trend toward higher mortality rate with older blood when transfused more than three RBC units |
Eikelboom et al. [50] | 2010 | 2002-2006 | Retrospective single-center | Canada | Yes | Cardiovascular disease | 4,933 | Greater risk of hospital mortality in the highest age quartile of RBCs |
Robinson et al. [51] | 2010 | 1999-2005 | Retrospective single-center | Canada | NR | PCI | 909 | Storage duration associated with 30-day mortality |
van Straten et al. [40] | 2011 | 1998-2007 | Retrospective single-center | Europe | Yes | Cardiac surgery | 3,597 | No effect of RBC storage duration on early or late postoperative mortality |
McKenny et al. [39] | 2011 | 2002-2007 | Retrospective single-center | Europe | Yes | Cardiac surgery | 1,153 | No association between RBC storage duration and postoperative mortality |
Kekre et al. [54] | 2011 | 2002-2007 | Retrospective single-center | Canada | Yes | HSCT | 555 | Non-relapse 100-day mortality reduced in the subgroup of patients receiving exclusively old blood (> 14 days old) |
Pettila et al. [29] | 2011 | 2008 | Prospective, multicenter | Australia - New Zealand | Mix | ICU | 757 | Exposure to the highest age quartile of RBCs associated with a higher hospital mortality rate compared to lowest quartile |
Hassan et al. [49] | 2011 | 2003-2005 | Retrospective single-center | USA | NR | Trauma | 820 | Number of older units not associated with increased mortality |
Saager et al. [31] | 2012 | 2005-2009 | Retrospective single-center | USA | Yes | Non-cardiac surgery | 6,994 | No relationship between median RBC storage duration and postoperative mortality (up to two years) |
Dunn et al. [52] | 2012 | 2000-2010 | Retrospective single-center | USA | NR | Liver transplant | 509 | Transfusion of older blood not associated with increased two-year mortality |
Kor et al. [28] | 2012 | 2008-2010 | Randomized single-center study | USA | Yes | ICU | 100 | Similar mortality between fresh and standard issue RBCs but not powered for this outcome |
Studies addressing ICU or hospital length of stay | ||||||||
Vamvakas et al. [56] | 2000 | 1995 | Retrospective single-center | USA | Mix (mostly not) | Cardiac surgery | 268 | No association between RBC storage duration and postoperative ICU and hospital LOS |
Keller et al. [58] | 2002 | 1998-1999 | Retrospective single-center | USA | No | Trauma | 86 | Number of units of blood older than 14 days associated with an increased hospital LOS |
Leal-Noval et al. [55] | 2003 | 1998-2000 | Prospective single-center | Europe | No | Cardiac surgery | 585 | No association between mean duration of RBC storage and ICU LOS |
Murrell et al. [48] | 2005 | 2001-2003 | Retrospective single-center | USA | Mix (95% LR) | Trauma | 275 | Association between 'dose of aged blood' and ICU LOS |
van de Watering et al. [38] | 2006 | 1993-1999 | Retrospective single-center | Europe | No | Cardiac surgery | 2,732 | No correlation between storage time variables and ICU LOS |
Yap et al. [41] | 2008 | 2001-2007 | Retrospective single-center | Australia | Mix (3.8% LR) | Cardiac surgery | 670 | No association between length of storage and ICU LOS |
McKenny et al. [39] | 2011 | 2002-2007 | Retrospective single-center | Europe | Yes | Cardiac surgery | 1,153 | No association between length of storage and ICU LOS |
Sanders et al. [57] | 2011 | 2005-2007 | Retrospective single-center | Europe | Yes | Cardiac surgery | 444 | Age of blood was a significant but modest predictor of postoperative LOS |
Kekre et al. [54] | 2011 | 2002-2007 | Retrospective single-center | Canada | Yes | HSCT | 555 | No correlation between age of transfused RBCs and hospital LOS |
Studies addressing age of transfused RBCs and occurrence of infections | ||||||||
Edna et al. [61] | 1998 | 1980-1992 | Retrospective single-center | Europe | No | Cancer | 240 | Age of RBCs not different in subjects developing postoperative infections and those who did not |
Vamvakas et al. [59] | 1999 | 1995 | Retrospective single-center | USA | Mix | Cardiac surgery | 256 | Independent relationship between the age of transfused RBCs and the incidence of postoperative pneumonia or wound infection |
Mynster et al. [53] | 2001 | 1991-1993 | Retrospective multicenter | Europe | No | Cancer | 740 | Increased risks of postoperative infections with transfusions of RBCs aged 20 days or more |
Offner et al. [64] | 2002 | 1992- | Retrospective single-center | USA | No | Trauma | 61 | Number of units older than 14 and 21 days as an independent risk factor for major infections |
Leal-Noval et al. [55] | 2003 | 1998-2000 | Prospective single-center | Europe | No | Cardiac surgery | 585 | Independent relation between the oldest RBC unit and postoperative pneumonia |
Taylor et al. [66] | 2006 | 2001-2003 | Prospective | USA | Mix | ICU | 449 | Maximum age of transfused RBCs not associated with increased risks of nosocomial infections |
Koch et al. [32] | 2008 | 1998-2006 | Retrospective single-center | USA | Mix | Cardiac surgery | 6,002 | Higher rates of postoperative sepsis or septicemia (but not pneumonia or wound infections) with older RBCs |
Weinberg et al. [46] | 2008 | 2000-2007 | Retrospective single-center | USA | Yes | Trauma | 430 | Occurrence of pneumonia related to the volume of old blood (> 14 days old) transfused |
Yap et al. [41] | 2008 | 2001-2007 | Retrospective single-center | Australia | Mix (3.8% LR) | Cardiac surgery | 670 | No association between storage of RBCs and postoperative pneumonia |
Dessertaine et al. [43] | 2008 | 2005-2006 | Retrospective single-center | Europe | Yes | ICU | 534 | No independent association between the age of RBCs and nosocomial infections |
Vandromme et al. [63] | 2009 | 2004-2007 | Retrospective single-center | USA | Yes | Trauma | 1,183 | Increased risks of pneumonia after transfusion of exclusively old RBCs (> 14 days) |
Basora et al. [113] | 2010 | 2004-2005 | Retrospective single-center | Europe | Yes | Knee arthroplasty | 335 | No independent association between age of transfused RBCs and postoperative wound infection |
McKenny et al. [39] | 2011 | 2002-2007 | Retrospective single-center | Europe | Yes | Cardiac surgery | 1,153 | No association between storage of RBCs and postoperative pneumonia |
Andreasen et al. [60] | 2011 | 2003-2008 | Retrospective multicenter | Europe | No | Cardiac surgery | 1,748 | Greater risk of postoperative wound infections and septicemia with RBCs older than 14 days |
Hassan et al. [49] | 2011 | 2003-2005 | Retrospective single-center | USA | NR | Trauma | 820 | Number of units older than 14 days as a significant risk factor for severe sepsis or septic shock |
Juffermans et al. [67] | 2011 | 2004-2007 | Retrospective single-center | Europe | Yes | ICU septic | 67 | Storage time as a confounder for the association of RBCs with infection |
Juffermans et al. [65] | 2012 | 2004-2007 | Retrospective single-center | Europe | Yes | Trauma/TBI | 196 | Modest association between transfusion of RBCs older than 14 days and occurrence of new infections |
Dunn et al. [52] | 2012 | 2000-2010 | Retrospective single-center | USA | NR | Liver transplant | 509 | No independent association between the age of RBCs and postoperative infections |
Studies addressing organ failure | ||||||||
Zallen et al. [68] | 1999 | NR | Retrospective single-center | USA | NR | Trauma | 63 | Mean age of blood (or number of units older than 14 or 21 days) as independent risk factors for MOF |
Vamvakas et al. [56] | 2000 | 1995 | Retrospective single-center | USA | Mix (mostly not) | Cardiac surgery | 268 | Length of RBC storage not associated with prolonged endotracheal intubation |
Keller et al. [58] | 2002 | 1998-1999 | Retrospective single-center | USA | No | Trauma | 86 | Duration of MV not associated with RBC storage duration |
Leal-Noval et al. [55] | 2003 | 1998-2000 | Prospective single-center | Europe | No | Cardiac surgery | 585 | No relationship between RBC storage duration and prolonged MV |
Gajic et al. [70] | 2004 | 2001 | Retrospective single-center | USA | Mix | ICU | 181 | No association between mean age or age of the oldest unit transfused and occurrence of ALI |
Yap et al. [41] | 2008 | 2001-2007 | Retrospective single-center | Australia | Mix (3.8% LR) | Cardiac surgery | 670 | No association between storage duration and occurrence of postoperative renal failure or prolonged MV |
Koch et al. [32] | 2008 | 1998-2006 | Retrospective single-center | USA | Mix | Cardiac surgery | 6,002 | Increased risk of a composite outcome (including MOF and renal failure) with transfusion of older blood; higher rates of MV > 72 hours when patients transfused only old RBC |
Weinberg et al. [46] | 2008 | 2000-2007 | Retrospective single-center | USA | Yes | Trauma | 430 | Old blood (> 14 days) associated with acute renal dysfunction after adjustment |
McKenny et al. [39] | 2011 | 2002-2007 | Retrospective single-center | Europe | Yes | Cardiac surgery | 1,153 | No association between storage duration and occurrence of postoperative renal failure or prolonged MV |
Sanders et al. [57] | 2011 | 2005-2007 | Retrospective single-center | Europe | Yes | Cardiac surgery | 444 | Higher rates of renal failure among patients transfused with old blood |
Kor et al. [28] | 2012 | 2008-2010 | Randomized single-center study | USA | Yes | ICU | 100 | Similar measures of pulmonary function after transfusion of either fresh or standard issue RBCs |
Weiskopf et al. [69] | 2012 | NR | Randomized single-center study | USA | Mix | Volunteers | 35 | Equivalent mild decrements in pulmonary gas exchange variables after transfusion of either fresh (1.7 hour) or older (> 21 days) RBCs |
Studies addressing tissue oxygenation and microcirculation | ||||||||
Marik et al. [71] | 1993 | NR | Prospective single-center study | USA | NR | ICU | 23 | Inverse correlation between the age of transfused RBCs and the maximal change in gastric mucosal pH (pHi) |
Fernandes et al. [72] | 2001 | 1996 | Randomized single-center study | South America | NR | ICU septic | 15 | No correlation between the age of transfused RBCs and the pHi |
Walsh et al. [73] | 2004 | 1999-2000 | Randomized single-center study | Europe | Yes | ICU | 22 | No difference in pHi or gastric to arterial PCO2 gap with transfusions of fresh or older RBCs |
Sakr et al. [75] | 2007 | NR | Prospective single-center | Europe | Yes | ICU | 35 | No correlation between the storage time and the changes in capillary perfusion |
Leal-Noval et al. [77] | 2008 | 2004-2006 | Prospective single-center | Europe | Yes | Severe TBI | 66 | Transfusion of RBCs aged more than 19 days failed to increase cerebral tissue oxygenation |
Kiraly et al. [79] | 2009 | NR | Prospective single-center | USA | NR | Trauma | 32 | Patients transfused with > 21 days old RBCs had a significant decrease in the area under the curve of tissue saturation (StO2) |
Creteur et al. [81] | 2009 | NR | Prospective single-center | Europe | Yes | ICU | 44 | No association between RBC storage time and oxygenation variables (NIRS) |
Yuruk et al. [76] | 2012 | NR | Randomized single-center study | Europe | Yes | Hematology patients | 20 | Increase in perfused vessel density similar in both RBC age groups |
Berra et al. [82] | 2012 | 2010 | Randomized single-center study | USA | Yes | Healthy volunteers | 9 | Reactive hyperemia index unchanged after transfusion of 40-day stored blood compared with transfusion of three-day stored blood |
Roberson et al. [83] | 2012 | NR | Prospective single-center | USA | Yes | Healthy volunteers | 8 | No effect of storage duration on tissue oxygen saturation and sublingual microcirculatory flow index |
Kopterides et al. [84] | 2012 | 2008-2011 | Prospective single-center | Europe | Mix | ICU septic | 37 | No relationship between age of RBCs and change in lactate/pyruvate ratio (microdialysis) |
Other outcomes | ||||||||
Wasser et al. [87] | 1989 | NR | Randomized single-center study | Europe | No | Cardiac surgery | 237 | No differences in postoperative bleeding, coagulation tests, or transfusion requirements |
Mynster et al. [53] | 2001 | 1991-1993 | Retrospective multicenter | Europe | No | Cancer | 740 | Higher recurrence rate of cancer in patients who received a transfusion of RBCs stored < 21 days |
Leal-Noval et al. [55] | 2003 | 1998-2000 | Prospective single-center | Europe | No | Cardiac surgery | 585 | No association between duration of storage of RBCs and postoperative myocardial infarction |
Weiskopf et al. [88] | 2006 | NR | Randomized single-center study | USA | No | Volunteers | 9 | Reversal of anemia-induced cognitive dysfunction similar after transfusion of fresh or stored RBCs |
Spinella et al. [47] | 2009 | 2004-2007 | Retrospective single-center | USA | Mix | Trauma | 202 | Association between maximum age of RBCs (> 21 or 28 days) and deep vein thrombosis (DVT) |
Naidech et al. [86] | 2011 | NR | Retrospective single-center | USA | NR | SAH | 119 | No association between age of RBCs and vasospasm or cerebral infarction |
Katsios et al. [85] | 2011 | 2001-2002 | Prospective single-center | Canada | No | ICU | 261 | No association between the age of transfused RBCs and the occurrence of DVT |
Cata et al. [89] | 2011 | 1998-2007 | Retrospective single-center | USA | NR | Prostate cancer | 316 | No association between the age of transfused RBCs and the five-year prostate cancer recurrence |