Study Finds Older Stored Blood - Worst Outcomes

This study has significance for anyone about to undergo surgery. 

In the first long-term look at whether the age of stored blood for transfusions or surgery affects outcome – scientists find people who receive blood more than two weeks old were 30 percent less likely to still be living a year later than those patients who received fresher blood.

The Cleveland Clinic research director, Dr. Colleen Gorman Koch says, “it’s like produce or meat – it has a limited shelf life”.

In the study, more than 6,000 patients were followed after bypass surgery. Typically those patients get at least one pint of blood and typically doctors and nurses have no idea of the age of the blood they are transfusing.

Those patients were followed between June 1998 and January 2006 and the researchers noted that about 3,100 got blood stored for more than 14 days - about the average age of stored blood nationally - while the rest received fresher blood. 

After a year, 93 percent of those who received the blood that was less than two weeks old were still alive compared to 89 percent of those who received blood stored for two weeks or more.  And those who got the older blood were more likely to have kidney failure and infections.

The FDA dictates that blood must be discarded after six weeks. That’s because blood degrades as red blood cells lose their ability to travel through blood vessels delivering much needed oxygen to tissues. To combat that shortfall, some doctors have tried to rejuvenate older blood with a nitric oxide infusion.

Minimizing blood transfusions during heart surgery is what the drug Trasylol was designed to do.

But IB News and others have reported the host of problems associated with its use including an increased risk of death. The drug has been taken off the market after 235 deaths were attributed to its use.

Still, some hospitals have already modified their need for transfusions and there has been a dramatic increase in the number of patients using their own blood for surgery. Autologous blood transfusions are an alternative to donated blood and the National Institutes of Health (NIH) provides information on which surgeries it’s best suited.    

The eye-opening study in the New England Journal of Medicine, is being called provocative and it is so far the largest published study to replicate what’s been seen in smaller studies.

Critics say it didn’t follow the gold standard for research, that is a randomized clinical trial where researchers would divide patients into two groups that intentionally are given newer blood and older blood.

Deciding who should have fresher blood raises ethical concerns, and besides, trying to keep up with the nation’s stored blood needs, about 14 million units every year,  is already a challenge.  #