SCCM: Old Blood Bad for Young Bodies

By Ed Susman, Contributing Writer, MedPage Today
Published: January 11, 2010
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

MIAMI BEACH -- If blood used for transfusions is more than 14 days old, it appears to significantly increase the risk that critically ill pediatric patients will suffer multiple organ dysfunction syndrome, researchers said here.

"While other investigators have found this problem among adults, no one has reported this before in children," Philip Spinella, MD, of Connecticut Children's Medical Center in Hartford told attendees at the Society of Critical Care Medicine meeting.

Spinella and colleagues accessed two data sets and found similar relationships among critically ill children who required blood transfusions. In one study of 455 children, the risk of suffering multiple organ dysfunction syndrome more than doubled (adjusted odds ratio 2.23; 95% CI 1.20 to 4.15, P<0.05) if children were transfused with red blood cells that were 14 days old or older.

The risk nearly tripled if the blood was 21 days or older (adjusted odds ratio 2.99; 95%CI 1.63 to 5.48, P>0.05).

"Stable critically ill children receiving red blood cell units with increased storage time may be at greater risk of developing new or progressive multiple organ dysfunction syndrome," said co-author Marisa Tucci, MD, of Sainte-Justine University Hospital, Montreal.

However, Tucci noted, their work comes with a caveat. "Definitive conclusions about a cause and effect relationship cannot be drawn from this secondary analysis of a prospective study," she said at her poster presentations. "These data justify undertaking a randomized controlled trial to address this question."

The researchers analyzed the results of the TRIPICU (Transfusion Requirements in Pediatric Intensive Care Units) study, which was conducted in 19 centers in the U.S. and Canada. That study analyzed strategies for transfusion. Age of the blood used in transfusion was a secondary outcome, Tucci explained.

In another study, 930 children were enrolled to analyze the rates of new or progressive multiple organ dysfunction syndrome, while a secondary analysis looked at whether the age of red blood cell transfusion played a role in hospital length of stay.

"We found that in critically ill children, transfusion of red blood cell units stored for longer than 14 days is independently associated with an increased occurrence of multiple organ dysfunction syndrome and prolonged stay in the pediatric intensive care unit," Spinella said

Nearly half of the children (447) were transfused; time of storage was known in 298 of the cases. "About half the children in these studies were infused with blood older than 14 days," Tucci said.

For patients receiving blood stored longer than 14 days, the adjusted odds ratio for an increased incidence of multiple organ failure was 1.87 (95% CI 1.06 to 3.31, P=0.03), she said.

"There was also a significant difference (<0.001) in the total length of pediatric intensive care unit stay of 3.7 days," she said.

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