Volume 165, Issue 1 pp. 3-16
review

Does prolonged storage of red blood cells cause harm?

Willy A. Flegel

Corresponding Author

Willy A. Flegel

Department of Transfusion Medicine and Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA

Correspondence: Willy A. Flegel, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Building 10, Room 1C711 MSC-1184, 10 Center Drive, Bethesda, MD 20892-1184, USA. E-mail: [email protected]Search for more papers by this author
Charles Natanson

Charles Natanson

Department of Transfusion Medicine and Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA

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Harvey G. Klein

Harvey G. Klein

Department of Transfusion Medicine and Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA

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First published: 25 January 2014
Citations: 95

Summary

Red blood cells (RBCs) degrade progressively during the weeks of refrigerated storage. No universally accepted definition of ‘fresh’ or ‘old’ RBCs exists. While practices vary from country to country, preservative solutions permitting shelf life as long as 7 weeks have been licenced. Transfusion of stored RBCs, particularly those at the end of the approved shelf life, has been implicated in adverse clinical outcomes. The results of observational analyses, animal models and studies in volunteers have proved provocative, controversial and contradictory. A recently completed randomized controlled trial (RCT) in premature infants exemplifies the difficulties with moderately sized clinical studies. Several other RCTs are in progress. The effect of RBC storage may well vary according to the clinical setting. Resolution of the importance of the storage lesion may require large pragmatic clinical trials. In the meantime, institutions involved in blood collection and transfusion should explore strategies that assure blood availability, while limiting the use of the oldest RBCs currently approved by regulation.

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