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Critical Care
Published in: Critical Care 3/2010

01-06-2010 | Commentary

Should fresh blood be recommended for intensive care patients?

Author: Bertrand Guidet

Published in: Critical Care | Issue 3/2010

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Abstract

Fresh blood has many potential advantages over older blood, but there is no evidence that these properties translate into clinical benefit for intensive care patients. The observational multicenter study by Karam and colleagues provides some evidence suggesting that blood stored for less than 14 days is better than older blood in terms of new organ failure and reduction in length of stay in pediatric intensive care units. Though in favor of using young blood, this study suffers from several limitations. As a consequence, it is ethical and certainly pertinent to conduct a randomized clinical trial in order to test the hypothesis that fresh blood might reduce mortality. The rationale is strong and the potential benefit of fresh blood is substantial.
Literature
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Karam O, Tucci M, Bateman ST, Ducruet T, Spinella PC, Randolph AG, Lacroix J: Association between length of storage of red blood cell units and outcome of critically ill children: a prospective observational study. Crit Care 2010, 14: R57. 10.1186/cc8953PubMedCentralCrossRefPubMed
2.
Bennett-Guerrero E, Veldman TH, Doctor A, Telen MJ, Ortel TL, Reid TS, Mulherin MA, Zhu H, Buck RD, Califf RM, McMahon TJ: Evolution of adverse changes in stored RBCs. Proc Natl Acad Sci USA 2007, 104: 17063-17068. 10.1073/pnas.0708160104PubMedCentralCrossRefPubMed
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Luten M, Roerdinkholder-Stoelwinder B, Schaap NP, de Grip WJ, Bos HJ, Bosman GJ: Survival of red blood cells after transfusion: a comparison between red cells concentrates of different storage periods. Transfusion 2008, 48: 1478-1485. 10.1111/j.1537-2995.2008.01734.xCrossRefPubMed
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Karam O, Tucci M, Toledano BJ, Robitaille N, Cousineau J, Thibault L, Lacroix J, Le Deist F: Length of storage and in vitro immunomodulation induced by prestorage leukoreduced red blood cells. Transfusion 2009, 49: 2326-2334. 10.1111/j.1537-2995.2009.02319.xCrossRefPubMed
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Sweeney J, Kouttab N, Kurtis J: Stored red blood cell supernatant facilitates thrombin generation. Transfusion 2009. [Epub: ahead of print]
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Spinella PC, Carroll CL, Staff I, Gross R, Mc Quay J, Keibel L, Wade CE, Holcomb JB: Duration of red blood cell storage is associated with increased incidence of deep vein thrombosis and in-hospital mortality in patients with traumatic injuries. Crit Care 2009, 13: R151. 10.1186/cc8050PubMedCentralCrossRefPubMed
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Fitzgerald RD, Martin CM, Dietz GE, Doig GS, Potter RF, Sibbald WJ: Transfusing red blood cells stored in citrate phosphate dextrose adenine-1 for 28 days fails to improve tissue oxygenation in rats. Crit Care Med 1997, 25: 726-732. 10.1097/00003246-199705000-00004CrossRefPubMed
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Kiraly LN Kiraly LN, Underwood S, Differding JA, Schreiber MA: Transfusion of aged packed red blood cells results in decreased tissue oxygenation in critically injured trauma patients. J Trauma 2009, 67: 29-32. 10.1097/TA.0b013e3181af6a8cCrossRefPubMed
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Bateman ST, Lacroix J, Boven K, Forbes P, Barton R, Thomas NJ, Jacobs B, Markovitz B, Goldstein B, Hanson JH, Li HA, Randolph AG, Pediatric Acute Lung Injury and Sepsis Investigators Network: Anemia, blood loss, and blood transfusions in North American children in the intensive care unit. Am J Respir Crit Care Med 2008, 178: 26-33. 10.1164/rccm.200711-1637OCCrossRefPubMed
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Lacroix J, Hébert PC, Hutchison JS, Hume HA, Tucci M, Ducruet T, Gauvin F, Collet JP, Toledano BJ, Robillard P, Joffe A, Biarent D, Meert K, Peters MJ, TRIPICU Investigators; Canadian Critical Care Trials Group; Pediatric Acute Lung Injury and Sepsis Investigators Network: Transfusion strategies for patients in pediatric intensive care units. N Engl J Med 2007, 356: 1609-1619. 10.1056/NEJMoa066240CrossRefPubMed
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Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC, Sebesta J, Jenkins D, Azarow K, Holcomb JB, 31st Combat Support Hospital Research Working Group: Risks associated with fresh whole blood and red blood cell transfusions in a combat support hospital. Crit Care Med 2007, 35: 2576-2581. 10.1097/01.CCM.0000285996.65226.A9CrossRefPubMed
Metadata
Title
Should fresh blood be recommended for intensive care patients?
Author
Bertrand Guidet
Publication date
01-06-2010
Publisher
BioMed Central
Published in
Critical Care / Issue 3/2010
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc9011

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