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Red blood cells (RBC) undergo biochemical and morphologic changes during storage and the changes known as “storage lesion” have raised concerns that RBCs stored for lengthy periods could increase mortality risks in patients receiving transfusions.We sought to analyze the association between aged RBCs and intensive care unit admissions, short-term and long-term survivals of patients undergoing hematopoietic stem cell transplantation (HSCT) and the association between overall survival and the number of RBCs transfused up to 100 days after HSCT. We reviewed the data from the Blood Bank database files from November 2008 to December 2009 for 334HSCT patientswho were alive 100 days after HSCT at the University of Texas MD Anderson Cancer Center. The patients were categorized into ICU vs. non-ICU patients after HSCT. We compared the age of RBCs, units of RBCs transfused and patients admitted to the ICU vs. non-ICU patients after HSCT. We found that the number of RBCs transfused correlated with overall survival and not with the age of the red cells transfused before and after HSCT.For both categories of patients: ICU vs. non-ICU patients, our retrospective analysis noted that those who received the most RBC transfusions had the worst survival. Received: 27 October, 2017; Accepted: 09 November, 2017; Published: 29 December, 2017 *Corresponding author: Fleur M Aung, Department of Laboratory Medicine, Unit 0800, 1515 Holcombe Blvd, Houston, Texas 75088, USA, Tel: (713) 792-8630, Fax: (713) 792-2634; E-mail: fmaung@mdanderson.org Symbiosis www.symbiosisonline.org www.symbiosisonlinepublishing.com Symbiosis Group * Corresponding author email: fmaung@mdanderson.org Introduction Red blood cells (RBCs) undergo well-documented biochemical and morphologic changes during storage. These “storage lesions,” 1-14and have raised concerns that stored older RBCs could increase mortality risk in patients receiving RBC transfusion. Donor RBCs contain a mixed population of cells ranging from newly formed reticulocytes to 120-day-old RBCs at the time of donation, and it has not been established with certainty whetherstorage lesions affect different stages of maturity equally.9Prolong storage of RBCs results in increased oxygen affinity after 14 days of storage due to progressive consumption of the high-energy phosphate (2,3-diphophoglycerate 2,3-DPG), decreased activity of most enzymes involved in energy metabolism (metabolic dysregulation), accumulation of reactive oxygen species (ROS), protein fragmentation and impairment of the band 3 transport metabolon, preferential loss of certain lipids and enrichment of others in the membrane fraction with exacerbation of membrane loss (vesiculation). There is uncertainty to the actual effectiveness and damage that allogeneic blood can cause to the transfused patient.13, 14Theprimary aim of blood storage in the United States has been to extend the storage life of a preciousand perishable product with the use of additive storage solutions (AS-1, AS-3, AS-5 or AS-7) to maximize its availability such as the using the oldest stored blood first to avoid wasting the blood. However, the clinical consequences of transfusion of aged RBCs remain unclear for patients undergoing hematopoietic stem cell transplantation (HSCT). Objectives The primary objective of the current study was to analyze the association between the age of RBCs transfused before and after HSCT and intensive care unit (ICU) admission as well as short-term (100 days after transplant) and long-term (>100 days after transplant) overall survival rates after HSCT. The secondary objective was to analyze the association between overallsurvival ratesand the number of RBC units transfused up to 100 days after HSCT. Methods Study Design The retrospective study design was approved by The University of TexasMD Anderson Cancer Center Institutional Review Board. Data were collected from the Blood Bank and Stem Cell and Cellular Therapy data-basesof our institution as well as patients’ electronic medical records.The 2008-2009 Blood Bank records were reviewed for adult and pediatric patients who had undergone HSCT. All data onRBCs transfused at MD AndersonCancer Center before (D-100 to D-1) and after (D0 to D+100) were included. Patients who had received a mixture of newer and agedRBCs were included in the study. For our analysis, the age of RBCs transfused was grouped using three cutoff points:

Overall survival in hematopoietic stem cell transplantation is correlated with the Number butnotwith the Age of Red Blood Cells Transfused