Tag Archives: Hematology

Age of Red Cells for Transfusion and Outcomes

Blood banks usually function by issuing the oldest available, patient-compatible products first. The goal is to preserve viability and functionality of cells and minimize waste of blood products.  Previous studies have shown conflicting evidence as to whether transfusion of older blood products is related to increased mortality. Therefore, Cooper et al set out to determine whether transfusion of older red blood cells (RBC) increased mortality for critically ill patients.

Their study findings support the current practice of using the oldest available RBCs for transfusion of critically ill adults, since there does not seem to be a benefit of using the freshest available RBCs.

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Evaluating Transfusion Strategies

Cancer patients are at increased risk of septic shock. Therefore, Bergamin et al set out to assess whether a restrictive strategy of red blood cell (RBC) transfusion reduces 28-day mortality when compared with a liberal strategy in cancer patients with septic shock.

They observed a survival trend favoring a liberal transfusion strategy in cancer patients with septic shock when compared with the restrictive strategy.

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The Efficacy of Platelet Transfusion

Platelet transfusion after acute spontaneous primary intracerebral hemorrhage in people taking antiplatelet therapy might reduce death or dependence by reducing the extent of the hemorrhage. Baharoglu et al therefore aimed to investigate whether platelet transfusion with standard care, compared with standard care alone, reduced death or dependence after intracerebral hemorrhage associated with antiplatelet therapy use.

They found that platelet transfusion seems inferior to standard care for people taking antiplatelet therapy before intracerebral hemorrhage.

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Red Blood Cell Transfusion and Associated Outcomes

Many studies have detailed increasing risks of morbidity and mortality associated with anemia in critically ill patients.  Despite these findings, transfusion of red blood cells (RBCs) to optimize oxygen delivery has been shown to carry its own inherent risks, ranging from the development of acute lung injury to immunomodulation to problems with the storage lesion and oxygen delivery. A study by Hassan et al adds to the mounting evidence regarding the deleterious effects of RBC transfusion by retrospectively looking at the impact of transfusion on pediatric trauma patients. The authors compared the outcomes of 81 children with trauma who were transfused with RBCs to 282 who did not receive any blood products.

They found that transfusion of packed RBCs is associated with higher risk of adverse outcomes independent of injury severity. Due to its retrospective nature, this study does not provide any new evidence proving that transfusion of RBCs can be harmful to critically ill patients, but it adds to the evidence of the effects in pediatric trauma patients.

Read the full Concise Critical Appraisal by logging into the SCCM eCommunity. Concise Critical Appraisal is a regular feature aimed at highlighting the best and most relevant literature from a variety of academic journals and encouraging discussion around recent studies and research.