Age of blood

[redstaff2003]

we experience same situation were clinicians think that transfusing 2 weeks old blood is bad for the recipient. our center still using first in first out...

[Mabel Adams]

All of a sudden, we have a cardiac surgeon requesting blood < 14 days old for adult pts. Has there been a new study published? What's the latest on this topic?

[tbostock]

We don't do cardiac surgery here, but since we are geographically far away from our blood supplier, we frequently transfuse near the expiration date (first in first out). We have one anesthesiologist who sends it back to us, he calls it "garbage blood". We're also holding our ground until more definitive studies are released. We are strong proponents of blood conservation and encourage the use of all transfusion alternatives prior to transfusion. It will be interesting to see how this one plays out...

[SMW]

They're likely using the March 20, 2008 NEJM article as the basis for their request. You may want to share with your team that although the article was from The Cleveland Clinic, the blood bank at that facility has not changed their issuing practices to provide blood less than 14 days old. There also has been much discussion concerning the anaylysis and interpretation of the data in that article.

[stu]

Wow: One set of Doctors want "this" and nothing else. Sounds like the discussions at our transfusion committee meetings. If they want fresh donor blood. How about line up a bunch of Directed donors (yes, that has other problems) so they can have what ever they want. I am sure the Ortho, OBGYN, Hemo and all the other Docs want fresh blood too.

Lets not forget the money people who don't want us expiring blood, so we do inventory management, the lousy public relations that would occur if we started to throw out blood after 14 days, and the facts that we collect what we can, when we can and expiration dates tend to come in clumps.

There is only one way to accoplish this. Have enough blood that you can turn over your entire blood supply every 14 days and not worry about inventory. Until we can do that they we can only do what's best for all our patients.

[tmsmach4]

Does anyone have any experience with the BioArray Solutions Array Imaging System AIS400C, especially validating one. Thanks in advance.

[carolyn swickard]

My question on this subject deals with the casual statement in these articles, especially the news articles, that we can "easily fix" this storage lesion by adding nitric oxide, I think it was, to these units. Does anyone have any idea at all what they are talking about?????

Another question - is this anything the anesthesiologists could adjust in the gas mixture they are giving the cardiac patients during the cariac surgery????

[Kip Kuttner]

With regard to making requests for products and changing policy, this NEJM study has been used to "confirm" what we intuitively believe about older blood. Older blood must be bad. Only red wine gets better with age (and perhaps some people).

We do know about the "storage lesion" and the RBCs look worse the longer they are stored. However at a recent conference, shortcomings to the study were discussed.

1) It is a retrospective study. There are 2 studies being started (one called the ABLE study) to address this issue, however it is believed that they do not have the statistical power to answer the question .... Stay tuned.

2)The two groups are not the same:

<14 d blood >14 d blood

Grp O xfusn 53 31

Grp O pt 51 30

WBC Red Prod 55 35

LVF 58 63

Valve Dz 4 7

PVD 54 58

In the <14 d study group, more group O units were transfused and there were fewer group O patients. Group O rbcs are slipperier and group o individuals make less vWF, making that group less prone to getting clots.

The <14 d study group has more LR blood suggesting that the >14 d study group was subjected to older surgical techniques.

The cases were not matched for heart function either the < 14 day group had better cardiac function (LVF, Valve disease, PVD).

3) Survival numbers were not adjusted. In the fine print there was a disclaimer that the survival numbers were unadjusted.

4) The blood age was treated as a dichotomous variable. How was the cut off of 14 days determined? Shouldn't the mortality increase as the units transfused age?

5) There is no plausible mechanism to explain the divergence of the survival curves seen after the transfused RBC should have been gone from the circulation...

So, while the study raises questions that should be answered, the study does not prove anything. Consequently there is really no information on which to base a policy change.

[geekay]

Hi,

I am yet to read that article. I had the opportunity to work in a cardiac centre where daily around 6-8 cardiac surgeries were being performed. One of the surgeions was very very particular about the first 2 units of bloods to be of the "same days; collection" ! whereas the second surgeon was more that happy to accept "less than five days' " old

red cells . and the success rate used to be 99 %. Though I had done my own home work about the protocols for cardiac surgeries, nowhere I could find any specificity regarding "fresh blood or warm blood" !

In contrast, in the hospital where I am attached to now, use less than 7 days old blood for cardiac cses, with almost the same success rate.

Ultimately, what I feel is...it is the surgeons likings and the place where he got trained....is what matters...

"Fresher the blood, better for the cardiac cases"....maybe thats an old saying ? ( as long as the Blood Bank has enough inventory of components .)

regards...

Edited March 18, 2009 by engeekay2003

[rcurrie]

When I started blood banking many moons ago, we would set up 6 whole blood, 6 packed cells, 6 FFP and 12 platelets for all CABG patients- there was no such thing as a redo CABG back then- your only options if there was restenosis were the type of casket and burial vs. cremation. Back in 2007 (before I changed careers back to railroading), our cardiac sugeons were just asking for a type and screen. Most of the patients went home with no transfusion whatsoever. After following cardiac surgery patients for almost 20 years, I have decided that the best transfusion is no transfusion. This doesn't hold for all patients, though. There is just something different about giving blood to someone who has had open heart surgery. We have all seen the studies, and I agree with those who advise against transfusion unless absolutely necessary.

BC