Monica Suet Ying Ng1,2,3, Angela Suet Yeung Ng4,5, Jessica Chan6, John-Paul Tung7,8,9, John Francis Fraser10,11. 1. Critical Care Research Group, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, Australia. monica.ng91@gmail.com. 2. School of Medicine, The University of Queensland, Herston, Brisbane, QLD, Australia. monica.ng91@gmail.com. 3. Research and Development, Australian Red Cross Blood Service, Kelvin Grove, Brisbane, QLD, Australia. monica.ng91@gmail.com. 4. Critical Care Research Group, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, Australia. angela.ng1@uqconnect.edu.au. 5. School of Medicine, The University of Queensland, Herston, Brisbane, QLD, Australia. angela.ng1@uqconnect.edu.au. 6. School of Medicine, The University of Queensland, Herston, Brisbane, QLD, Australia. jessica.chan4@uqconnect.edu.au. 7. Critical Care Research Group, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, Australia. JTung@redcrossblood.org.au. 8. School of Medicine, The University of Queensland, Herston, Brisbane, QLD, Australia. JTung@redcrossblood.org.au. 9. Research and Development, Australian Red Cross Blood Service, Kelvin Grove, Brisbane, QLD, Australia. JTung@redcrossblood.org.au. 10. Critical Care Research Group, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, Australia. TPCH-CCRG@health.qld.gov.au. 11. School of Medicine, The University of Queensland, Herston, Brisbane, QLD, Australia. TPCH-CCRG@health.qld.gov.au.
Abstract
PURPOSE: There is substantial conjecture regarding the clinical significance of packed red blood cell (PRBC) changes that occur during in vitro storage. Here, we present a meta- and systematic analysis of adult studies published between 1994 and 2015 with the aim of updating existing quantitative reviews and providing a comprehensive cover of the six most commonly studied outcomes-mortality, infection, renal dysfunction, multiple organ dysfunction syndrome (MODS), thrombotic complications and prolonged hospital length of stay. METHODS: Computerised searches of Pubmed and EMBASE identified publications that reported target outcomes and PRBC storage duration prior to transfusion. Bibliographies of relevant literature were manually searched to incorporate missed studies. Randomised controlled trial (RCT) data was meta-analysed using a random effects model with Cochrane Collaboration Review Manager (RevMan) version 5.1 software. Observational investigations were systematically reviewed. RESULTS: Sixty-four papers were selected covering 462,581 patients with the majority of studies being observational in nature. Meta-analysis of eight RCTs demonstrated a trend towards decreased mortality with stored PRBC transfusion; albeit this effect was not statistically significant (OR 0.91, 95 % CI 0.78-1.05, p = 0.20). In a small subset of intensive care unit (ICU), cardiac surgery and trauma patients; observational studies suggested that prolonged storage may be correlated with increased mortality. Trauma and cardiac surgery patients appeared to be most susceptible to the potential infectious complications of stored PRBCs. Stored PRBCs were unlikely to affect thrombotic complications or hospital length of stay. There were inadequate data to determine whether stored PRBCs had clinically relevant effects on renal dysfunction and MODS. CONCLUSION: Although literature presents a concerning picture of potential storage complications, current findings are too inconsistent to drive changes in clinical practice. Results from current RCTs will likely play a role in PRBC age guidelines for cardiac surgery and ICU patients. However, these studies may be less efficacious at detecting small effects that are limited to specific subpopulations.
PURPOSE: There is substantial conjecture regarding the clinical significance of packed red blood cell (PRBC) changes that occur during in vitro storage. Here, we present a meta- and systematic analysis of adult studies published between 1994 and 2015 with the aim of updating existing quantitative reviews and providing a comprehensive cover of the six most commonly studied outcomes-mortality, infection, renal dysfunction, multiple organ dysfunction syndrome (MODS), thrombotic complications and prolonged hospital length of stay. METHODS: Computerised searches of Pubmed and EMBASE identified publications that reported target outcomes and PRBC storage duration prior to transfusion. Bibliographies of relevant literature were manually searched to incorporate missed studies. Randomised controlled trial (RCT) data was meta-analysed using a random effects model with Cochrane Collaboration Review Manager (RevMan) version 5.1 software. Observational investigations were systematically reviewed. RESULTS: Sixty-four papers were selected covering 462,581 patients with the majority of studies being observational in nature. Meta-analysis of eight RCTs demonstrated a trend towards decreased mortality with stored PRBC transfusion; albeit this effect was not statistically significant (OR 0.91, 95 % CI 0.78-1.05, p = 0.20). In a small subset of intensive care unit (ICU), cardiac surgery and traumapatients; observational studies suggested that prolonged storage may be correlated with increased mortality. Trauma and cardiac surgery patients appeared to be most susceptible to the potential infectious complications of stored PRBCs. Stored PRBCs were unlikely to affect thrombotic complications or hospital length of stay. There were inadequate data to determine whether stored PRBCs had clinically relevant effects on renal dysfunction and MODS. CONCLUSION: Although literature presents a concerning picture of potential storage complications, current findings are too inconsistent to drive changes in clinical practice. Results from current RCTs will likely play a role in PRBC age guidelines for cardiac surgery and ICU patients. However, these studies may be less efficacious at detecting small effects that are limited to specific subpopulations.
Authors: Daryl J Kor; Rahul Kashyap; Richard B Weiskopf; Gregory A Wilson; Camille M van Buskirk; Jeffrey L Winters; Michael Malinchoc; Rolf D Hubmayr; Ognjen Gajic Journal: Am J Respir Crit Care Med Date: 2012-01-26 Impact factor: 21.405
Authors: Marie E Steiner; Paul M Ness; Susan F Assmann; Darrell J Triulzi; Steven R Sloan; Meghan Delaney; Suzanne Granger; Elliott Bennett-Guerrero; Morris A Blajchman; Vincent Scavo; Jeffrey L Carson; Jerrold H Levy; Glenn Whitman; Pamela D'Andrea; Shelley Pulkrabek; Thomas L Ortel; Larissa Bornikova; Thomas Raife; Kathleen E Puca; Richard M Kaufman; Gregory A Nuttall; Pampee P Young; Samuel Youssef; Richard Engelman; Philip E Greilich; Ronald Miles; Cassandra D Josephson; Arthur Bracey; Rhonda Cooke; Jeffrey McCullough; Robert Hunsaker; Lynne Uhl; Janice G McFarland; Yara Park; Melissa M Cushing; Charles T Klodell; Ravindra Karanam; Pamela R Roberts; Cornelius Dyke; Eldad A Hod; Christopher P Stowell Journal: N Engl J Med Date: 2015-04-09 Impact factor: 91.245
Authors: Jeanne E Hendrickson; Eldad A Hod; Krystalyn E Hudson; Steven L Spitalnik; James C Zimring Journal: Transfusion Date: 2011-06-03 Impact factor: 3.157
Authors: Herb A Phelan; Alexander L Eastman; Kim Aldy; Elizabeth A Carroll; Paul A Nakonezny; Tiffany Jan; Jessi L Howard; Yixiao Chen; Randall S Friese; Joseph P Minei Journal: Am J Surg Date: 2011-09-14 Impact factor: 2.565
Authors: Jordan A Weinberg; Gerald McGwin; Russell L Griffin; Vu Q Huynh; Samuel A Cherry; Marisa B Marques; Donald A Reiff; Jeffrey D Kerby; Loring W Rue Journal: J Trauma Date: 2008-08
Authors: María García-Roa; María Del Carmen Vicente-Ayuso; Alejandro M Bobes; Alexandra C Pedraza; Ataúlfo González-Fernández; María Paz Martín; Isabel Sáez; Jerard Seghatchian; Laura Gutiérrez Journal: Blood Transfus Date: 2017-05 Impact factor: 3.443
Authors: Tyler J Loftus; Scott C Brakenridge; Travis W Murphy; Linda L Nguyen; Frederick A Moore; Philip A Efron; Alicia M Mohr Journal: J Surg Res Date: 2018-09 Impact factor: 2.192
Authors: Alexander Bautista; Theodore B Wright; Janice Meany; Sunitha K Kandadai; Benjamin Brown; Kareim Khalafalla; Saeed Hashem; Jason W Smith; Tayyeb M Ayyoubi; Jarrod E Dalton; Anupama Wadhwa; Daniel I Sessler; Detlef Obal Journal: Biomed Res Int Date: 2017-05-14 Impact factor: 3.411
Authors: Monica S Y Ng; Michael David; Rutger A Middelburg; Angela S Y Ng; Jacky Y Suen; John-Paul Tung; John F Fraser Journal: Haematologica Date: 2018-05-24 Impact factor: 9.941