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Red blood cell transfusion in adults: Storage, specialized modifications, and infusion parameters

INTRODUCTION

Red blood cell (RBC) transfusions are given to raise the hemoglobin level in patients with anemia or to replace losses after acute bleeding episodes. Storage of red cells has been enhanced by the development of preservative solutions; in addition, several types of components are available for use in selected circumstances to minimize complications. This topic review will discuss the storage and use of these various preparations.

The administration of RBC transfusions in adults, including issues of storage, specialized modifications, and infusion, is discussed here. Indications for RBC transfusion, transfusion of RBCs in infants and children, and transfusion complications are discussed separately.

(See "Indications and hemoglobin thresholds for red blood cell transfusion in the adult".)

(See "Massive blood transfusion".)

(See "Indications for red blood cell transfusion in infants and children".)

                         

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Literature review current through: Jul 2014. | This topic last updated: Jul 8, 2014.
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References
Top
  1. Collins JA. Problems associated with the massive transfusion of stored blood. Surgery 1974; 75:274.
  2. Hess JR, Rugg N, Knapp AD, et al. Successful storage of RBCs for 10 weeks in a new additive solution. Transfusion 2000; 40:1012.
  3. Hess JR, Hill HR, Oliver CK, et al. Twelve-week RBC storage. Transfusion 2003; 43:867.
  4. Högman CF, Meryman HT. Red blood cells intended for transfusion: quality criteria revisited. Transfusion 2006; 46:137.
  5. Thomas S, Hancock V, Cardigan R. The 30 minute rule for red blood cells: in vitro quality assessment after repeated exposure to 30°C. Transfusion 2013; 53:1169.
  6. Dumani D, Goldfinger D, Ziman A. Is the 30-minute rule still applicable in the 21st century? Transfusion 2013; 53:1150.
  7. Ramirez-Arcos S, Perkins H, Kou Y, et al. Bacterial growth in red blood cell units exposed to uncontrolled temperatures: challenging the 30-minute rule. Vox Sang 2013; 105:100.
  8. Standards for Blood Banks and Transfusion Services, 28th ed, AABB, Bethesda, MD 2012.
  9. Lecak J, Scott K, Young C, et al. Evaluation of red blood cells stored at -80 degrees C in excess of 10 years. Transfusion 2004; 44:1306.
  10. Fabricant L, Kiraly L, Wiles C, et al. Cryopreserved deglycerolized blood is safe and achieves superior tissue oxygenation compared with refrigerated red blood cells: a prospective randomized pilot study. J Trauma Acute Care Surg 2013; 74:371.
  11. Whillier S, Raftos JE, Sparrow RL, Kuchel PW. The effects of long-term storage of human red blood cells on the glutathione synthesis rate and steady-state concentration. Transfusion 2011; 51:1450.
  12. Luten M, Roerdinkholder-Stoelwinder B, Schaap NP, et al. Survival of red blood cells after transfusion: a comparison between red cells concentrates of different storage periods. Transfusion 2008; 48:1478.
  13. Hess JR, Sparrow RL, van der Meer PF, et al. Red blood cell hemolysis during blood bank storage: using national quality management data to answer basic scientific questions. Transfusion 2009; 49:2599.
  14. Heaton WM. Red blood cell hemolysis: an old standard in changing times. Transfusion 2009; 49:2551.
  15. Council of Europe. Guide to the preparation, use and quality assurance of blood components. In: Guide to the preparation, use and quality assurance of blood components. Recommentation R (95) 15, 11th ed, of Europe Publishing, Strasbourg 2005. p.1.
  16. Dumont LJ, AuBuchon JP. Evaluation of proposed FDA criteria for the evaluation of radiolabeled red cell recovery trials. Transfusion 2008; 48:1053.
  17. Walsh TS, McArdle F, McLellan SA, et al. Does the storage time of transfused red blood cells influence regional or global indexes of tissue oxygenation in anemic critically ill patients? Crit Care Med 2004; 32:364.
  18. Mannucci PM, Federici AB, Sirchia G. Hemostasis testing during massive blood replacement. A study of 172 cases. Vox Sang 1982; 42:113.
  19. Reed RL Jr, Ciavarella D, Heimbach DM, et al. Prophylactic platelet administration during massive transfusion. A prospective, randomized, double-blind clinical study. Ann Surg 1986; 203:48.
  20. Simon GE, Bove JR. The potassium load from blood transfusion. Postgrad Med 1971; 49:61.
  21. Baz EM, Kanazi GE, Mahfouz RA, Obeid MY. An unusual case of hyperkalaemia-induced cardiac arrest in a paediatric patient during transfusion of a 'fresh' 6-day-old blood unit. Transfus Med 2002; 12:383.
  22. Smith HM, Farrow SJ, Ackerman JD, et al. Cardiac arrests associated with hyperkalemia during red blood cell transfusion: a case series. Anesth Analg 2008; 106:1062.
  23. Mount DB, Zandi-Nejad. Disorders of potassium balance. In: Brenner and Rector's The Kidney, Brenner BM. (Ed), WB Saunders, Philadelphia 2004. p.997.
  24. Perkins RM, Aboudara MC, Abbott KC, Holcomb JB. Resuscitative hyperkalemia in noncrush trauma: a prospective, observational study. Clin J Am Soc Nephrol 2007; 2:313.
  25. Cid J, Ramiro L, Bertran S, et al. Efficacy in reducing potassium load in irradiated red cell bags with a potassium adsorption filter. Transfusion 2008; 48:1966.
  26. Strauss RG. Data-driven blood banking practices for neonatal RBC transfusions. Transfusion 2000; 40:1528.
  27. Casper JT, Varma RR, Lewis JD, et al. Exchange transfusion in Reye's syndrome with saline-washed red blood cells. Transfusion 1976; 16:130.
  28. McMahon TJ, Moon RE, Luschinger BP, et al. Nitric oxide in the human respiratory cycle. Nat Med 2002; 8:711.
  29. Doctor A, Platt R, Sheram ML, et al. Hemoglobin conformation couples erythrocyte S-nitrosothiol content to O2 gradients. Proc Natl Acad Sci U S A 2005; 102:5709.
  30. James PE, Lang D, Tufnell-Barret T, et al. Vasorelaxation by red blood cells and impairment in diabetes: reduced nitric oxide and oxygen delivery by glycated hemoglobin. Circ Res 2004; 94:976.
  31. Bennett-Guerrero E, Veldman TH, Doctor A, et al. Evolution of adverse changes in stored RBCs. Proc Natl Acad Sci U S A 2007; 104:17063.
  32. Winslow RM, Intaglietta M. Red cell age and loss of function: advance or SNO-job? Transfusion 2008; 48:411.
  33. Ho J, Sibbald WJ, Chin-Yee IH. Effects of storage on efficacy of red cell transfusion: when is it not safe? Crit Care Med 2003; 31:S687.
  34. Lelubre C, Piagnerelli M, Vincent JL. Association between duration of storage of transfused red blood cells and morbidity and mortality in adult patients: myth or reality? Transfusion 2009; 49:1384.
  35. Zubair AC. Clinical impact of blood storage lesions. Am J Hematol 2010; 85:117.
  36. Baek JH, D'Agnillo F, Vallelian F, et al. Hemoglobin-driven pathophysiology is an in vivo consequence of the red blood cell storage lesion that can be attenuated in guinea pigs by haptoglobin therapy. J Clin Invest 2012; 122:1444.
  37. Tinmouth A, Fergusson D, Yee IC, et al. Clinical consequences of red cell storage in the critically ill. Transfusion 2006; 46:2014.
  38. Zallen G, Offner PJ, Moore EE, et al. Age of transfused blood is an independent risk factor for postinjury multiple organ failure. Am J Surg 1999; 178:570.
  39. Purdy FR, Tweeddale MG, Merrick PM. Association of mortality with age of blood transfused in septic ICU patients. Can J Anaesth 1997; 44:1256.
  40. Vamvakas EC, Carven JH. Transfusion and postoperative pneumonia in coronary artery bypass graft surgery: effect of the length of storage of transfused red cells. Transfusion 1999; 39:701.
  41. Basran S, Frumento RJ, Cohen A, et al. The association between duration of storage of transfused red blood cells and morbidity and mortality after reoperative cardiac surgery. Anesth Analg 2006; 103:15.
  42. Mynster T, Nielsen HJ, Danish RANX05 Colorectal Cancer Study Group. Storage time of transfused blood and disease recurrence after colorectal cancer surgery. Dis Colon Rectum 2001; 44:955.
  43. Offner PJ, Moore EE, Biffl WL, et al. Increased rate of infection associated with transfusion of old blood after severe injury. Arch Surg 2002; 137:711.
  44. Leal-Noval SR, Jara-López I, García-Garmendia JL, et al. Influence of erythrocyte concentrate storage time on postsurgical morbidity in cardiac surgery patients. Anesthesiology 2003; 98:815.
  45. Koch CG, Li L, Sessler DI, et al. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med 2008; 358:1229.
  46. Leal-Noval SR, Muñoz-Gómez M, Arellano-Orden V, et al. Impact of age of transfused blood on cerebral oxygenation in male patients with severe traumatic brain injury. Crit Care Med 2008; 36:1290.
  47. Weinberg JA, McGwin G Jr, Marques MB, et al. Transfusions in the less severely injured: does age of transfused blood affect outcomes? J Trauma 2008; 65:794.
  48. Eikelboom JW, Cook RJ, Liu Y, Heddle NM. Duration of red cell storage before transfusion and in-hospital mortality. Am Heart J 2010; 159:737.
  49. Edgren G, Kamper-Jørgensen M, Eloranta S, et al. Duration of red blood cell storage and survival of transfused patients (CME). Transfusion 2010; 50:1185.
  50. Gauvin F, Spinella PC, Lacroix J, et al. Association between length of storage of transfused red blood cells and multiple organ dysfunction syndrome in pediatric intensive care patients. Transfusion 2010; 50:1902.
  51. Sanders J, Patel S, Cooper J, et al. Red blood cell storage is associated with length of stay and renal complications after cardiac surgery. Transfusion 2011; 51:2286.
  52. van de Watering L, Lorinser J, Versteegh M, et al. Effects of storage time of red blood cell transfusions on the prognosis of coronary artery bypass graft patients. Transfusion 2006; 46:1712.
  53. Vamvakas EC, Carven JH. Length of storage of transfused red cells and postoperative morbidity in patients undergoing coronary artery bypass graft surgery. Transfusion 2000; 40:101.
  54. Weiskopf RB, Feiner J, Hopf H, et al. Fresh blood and aged stored blood are equally efficacious in immediately reversing anemia-induced brain oxygenation deficits in humans. Anesthesiology 2006; 104:911.
  55. Vamvakas EC. Meta-analysis of clinical studies of the purported deleterious effects of "old" (versus "fresh") red blood cells: are we at equipoise? Transfusion 2010; 50:600.
  56. Vamvakas EC. Purported deleterious effects of "old" versus "fresh" red blood cells: an updated meta-analysis. Transfusion 2011; 51:1122.
  57. Phelan HA, Eastman AL, Aldy K, et al. Prestorage leukoreduction abrogates the detrimental effect of aging on packed red cells transfused after trauma: a prospective cohort study. Am J Surg 2012; 203:198.
  58. Kor DJ, Kashyap R, Weiskopf RB, et al. Fresh red blood cell transfusion and short-term pulmonary, immunologic, and coagulation status: a randomized clinical trial. Am J Respir Crit Care Med 2012; 185:842.
  59. 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.
  60. Donadee C, Raat NJ, Kanias T, et al. Nitric oxide scavenging by red blood cell microparticles and cell-free hemoglobin as a mechanism for the red cell storage lesion. Circulation 2011; 124:465.
  61. Hod EA, Brittenham GM, Billote GB, et al. Transfusion of human volunteers with older, stored red blood cells produces extravascular hemolysis and circulating non-transferrin-bound iron. Blood 2011; 118:6675.
  62. Adamson JW. New blood, old blood, or no blood? N Engl J Med 2008; 358:1295.
  63. Bennett-Guerrero E, Stafford-Smith M, Waweru PM, et al. A prospective, double-blind, randomized clinical feasibility trial of controlling the storage age of red blood cells for transfusion in cardiac surgical patients. Transfusion 2009; 49:1375.
  64. Steiner ME, Stowell C. Does red blood cell storage affect clinical outcome? When in doubt, do the experiment. Transfusion 2009; 49:1286.
  65. Rao SV, Califf RM. Is old blood bad blood? Am Heart J 2010; 159:710.
  66. Kim-Shapiro DB, Lee J, Gladwin MT. Storage lesion: role of red blood cell breakdown. Transfusion 2011; 51:844.
  67. van de Watering L, Biomedical Excellence for Safer Transfusion (BEST) Collaborative. Pitfalls in the current published observational literature on the effects of red blood cell storage. Transfusion 2011; 51:1847.
  68. Counts RB, Haisch C, Simon TL, et al. Hemostasis in massively transfused trauma patients. Ann Surg 1979; 190:91.
  69. Lipson SM, Shepp DH, Match ME, et al. Cytomegalovirus infectivity in whole blood following leukocyte reduction by filtration. Am J Clin Pathol 2001; 116:52.
  70. Rosenbaum L, Tomasulo P, Lipton KS, Ness P. The reintroduction of nonleukoreduced blood: would patients and clinicians agree? Transfusion 2011; 51:2739.
  71. Góes EG, Borges JC, Covas DT, et al. Quality control of blood irradiation: determination T cells radiosensitivity to cobalt-60 gamma rays. Transfusion 2006; 46:34.
  72. Treleaven J, Gennery A, Marsh J, et al. Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology blood transfusion task force. Br J Haematol 2011; 152:35.
  73. Hillyer CD, Tiegerman KO, Berkman EM. Evaluation of the red cell storage lesion after irradiation in filtered packed red cell units. Transfusion 1991; 31:497.
  74. Davey RJ, McCoy NC, Yu M, et al. The effect of prestorage irradiation on posttransfusion red cell survival. Transfusion 1992; 32:525.
  75. Góes EG, Ottoboni MA, Palma PV, et al. Quality control of blood irradiation with a teletherapy unit: damage to stored red blood cells after cobalt-60 gamma irradiation. Transfusion 2008; 48:332.
  76. Relevy H, Koshkaryev A, Manny N, et al. Blood banking-induced alteration of red blood cell flow properties. Transfusion 2008; 48:136.
  77. Zimmermann R, Wintzheimer S, Weisbach V, et al. Influence of prestorage leukoreduction and subsequent irradiation on in vitro red blood cell (RBC) storage variables of RBCs in additive solution saline-adenine-glucose-mannitol. Transfusion 2009; 49:75.
  78. Olsson ML, Clausen H. Modifying the red cell surface: towards an ABO-universal blood supply. Br J Haematol 2008; 140:3.
  79. Bagnis C, Chiaroni J, Bailly P. Elimination of blood group antigens: hope and reality. Br J Haematol 2011; 152:392.
  80. Giarratana MC, Rouard H, Dumont A, et al. Proof of principle for transfusion of in vitro-generated red blood cells. Blood 2011; 118:5071.
  81. AABB Technical Manual, 17th, Roback JD, Grossman BJ, Harris T, et al. (Eds), American Association of Blood Banks Press, Bethesda, MD 2011. p.237.
  82. AABB, American Red Cross, America’s Blood Centers, and Armed Services Blood Program. Circular of Information for the use of human blood and blood components. http://www.aabb.org/resources/bct/Documents/coi0809r.pdf.
  83. Guidelines for the Administration of Blood Products. Australian and New Zealand Society of Blood Transfusion Ltd and Royal College of Nursing Australia, 2nd ed, Sydney Australia, December 2011. http://www.anzsbt.org.au/publications/documents/ANZSBT_Guidelines_Administration_Blood_Products_2ndEd_Dec_2011_Hyperlinks.pdf (Accessed on January 22, 2013).
  84. Elizalde JI, Clemente J, Marín JL, et al. Early changes in hemoglobin and hematocrit levels after packed red cell transfusion in patients with acute anemia. Transfusion 1997; 37:573.
  85. Wiesen AR, Hospenthal DR, Byrd JC, et al. Equilibration of hemoglobin concentration after transfusion in medical inpatients not actively bleeding. Ann Intern Med 1994; 121:278.