Stephen M Cohn1, Mark DeRosa2, Ashwini Kumar3, Chantal Harrison4, Daniel Dent2, Sunthosh Sivam5, Janet McCarthy2, Sherrie Warner6, Susan Williams6, Joel E Michalek7, Philip Spinella8. 1. University of Texas Health Science Center at San Antonio, Department of Surgery, Division of Trauma and Emergency Surgery, 7703 Floyd Curl Drive, MC 7740, San Antonio, TX 78229, United States. Electronic address: cohn@uthscsa.edu. 2. University of Texas Health Science Center at San Antonio, Department of Surgery, Division of Trauma and Emergency Surgery, 7703 Floyd Curl Drive, MC 7740, San Antonio, TX 78229, United States. 3. University of Texas Health Science Center at San Antonio, Department of Surgery, Residency Office, 7703 Floyd Curl Drive, MC 78229, San Antonio, TX 78229, United States. 4. University of Texas Health Science Center at San Antonio, Department of Pathology, 7703 Floyd Curl Drive, MC 7750, San Antonio, TX 78229, United States. 5. University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States. 6. University Health System, 4502 Medical Drive, San Antonio, TX 78229, United States. 7. University of Texas Health Science Center at San Antonio, Department of Epidemiology & Biostatistics, 7703 Floyd Curl Drive, MC 78229, San Antonio, TX 78229, United States. 8. Department of Pediatrics, Washington University in St. Louis, St Louis, MO 63110, United States.
Abstract
UNLABELLED: Following injury, transfusion of red blood cells (RBCs) of increased storage duration has been associated with an increased morbidity and mortality. Prospective trials focusing on the impact of the storage age of RBCs in severely bleeding trauma patients have failed to accrue patients. This has been attributed to an inability to maintain a large inventory of fresh RBCs, and the difficulties in obtaining consent in severely bleeding trauma patients. To address these issues, we performed a prospective, observational pilot study to evaluate the feasibility of conducting a trial focusing on RBC age in patients following injury. METHODS: Patients with bleeding due to trauma were transfused RBCs ≤10 day old if they were ABO blood Type O (Group O) or were transfused the oldest RBCs in inventory if they were Type A, B or AB (Group A/B/AB). Clinicians were unaware of the specific age of the RBCs. RESULTS: 63 patients were analyzed (Group O, n=19; Group A/B/AB, n=44). Half of all patients had severe injuries ISS (median 22). The median admission base deficit was -5 mEq/L, and median total 24h use of RBC and FFP was 1.2 L. The age of RBCs transfused to Group O was significantly lower than for Group A/B/AB [median (IQR) A/B/AB=18.4 (11.4-25.4) days, and Group O=6 (4.2-7.8) days; p<0.001]. CONCLUSIONS: It appears feasible to conduct a RBC age trial in trauma patients using ABO blood type to construct comparative groups. Adequate RBC age separation between cohorts and reduced RBC age in the "young" group of patients who received units ≤10 days old was achieved.
UNLABELLED: Following injury, transfusion of red blood cells (RBCs) of increased storage duration has been associated with an increased morbidity and mortality. Prospective trials focusing on the impact of the storage age of RBCs in severely bleeding traumapatients have failed to accrue patients. This has been attributed to an inability to maintain a large inventory of fresh RBCs, and the difficulties in obtaining consent in severely bleeding traumapatients. To address these issues, we performed a prospective, observational pilot study to evaluate the feasibility of conducting a trial focusing on RBC age in patients following injury. METHODS:Patients with bleeding due to trauma were transfused RBCs ≤10 day old if they were ABO blood Type O (Group O) or were transfused the oldest RBCs in inventory if they were Type A, B or AB (Group A/B/AB). Clinicians were unaware of the specific age of the RBCs. RESULTS: 63 patients were analyzed (Group O, n=19; Group A/B/AB, n=44). Half of all patients had severe injuries ISS (median 22). The median admission base deficit was -5 mEq/L, and median total 24h use of RBC and FFP was 1.2 L. The age of RBCs transfused to Group O was significantly lower than for Group A/B/AB [median (IQR) A/B/AB=18.4 (11.4-25.4) days, and Group O=6 (4.2-7.8) days; p<0.001]. CONCLUSIONS: It appears feasible to conduct a RBC age trial in traumapatients using ABO blood type to construct comparative groups. Adequate RBC age separation between cohorts and reduced RBC age in the "young" group of patients who received units ≤10 days old was achieved.
Authors: Lauren M McDaniel; Darrell J Triulzi; James Cramer; Brian S Zuckerbraun; Jason L Sperry; Andrew B Peitzman; Jay S Raval; Matthew D Neal Journal: J Blood Transfus Date: 2014-09-10