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Transfusion of recently donated (fresh) red blood cells ( RBC s) does not improve survival in comparison with current practice, while safety of the oldest stored units is yet to be established: a meta‐analysis
Author(s) -
Remy K. E.,
Sun J.,
Wang D.,
Welsh J.,
Solomon S. B.,
Klein H. G.,
Natanson C.,
CortésPuch I.
Publication year - 2016
Publication title -
vox sanguinis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.68
H-Index - 83
eISSN - 1423-0410
pISSN - 0042-9007
DOI - 10.1111/vox.12380
Subject(s) - observational study , medicine , randomized controlled trial , meta analysis , blood transfusion , transfusion medicine , blood preservation , clinical trial , physiology
Background and Objectives Preclinical studies generated the hypothesis that older stored red blood cells ( RBC s) can increase transfusion risks. To examine the most updated and complete clinical evidence and compare results between two trial designs, we assessed both observational studies and randomized controlled trials ( RCT s) studying the effect of RBC storage age on mortality. Materials and Methods Five databases were searched through December 2014 for studies comparing mortality using transfused RBC s having longer and shorter storage times. Results Analysis of six RCT s found no significant differences in survival comparing current practice (average storage age of 2 to 3 weeks) to transfusion of 1‐ to 10‐day‐old RBC s ( OR 0·91, 95% CI 0·77‐1·07). RBC storage age was lower in RCT s vs. observational studies ( P = 0·01). The 31 observational studies found an increased risk of death ( OR 1·13, 95% CI 1·03–1·24) ( P = 0·01) with increasing age of RBC s, a different mortality effect than RCT s ( P = 0·02). Conclusion RCT s established that transfusion of 1‐ to 10‐day‐old stored RBC s is not superior to current practice. The apparent discrepancy in mortality between analyses of RCT s and observational studies may in part relate to differences in hypotheses tested and ages of stored RBC s studied. Further trials investigating 1‐ to 10‐day‐old stored RBC benefits would seem of lower priority than studies to determine whether 4‐ to 6‐week stored units have safety and efficacy equivalent to the 2‐ to 3‐week‐old stored RBC s commonly transfused today.