Quintero MEO, Martínez RKS, Gutiérrez MCA

Language: Spanish
References: 36
Page: 463-471
PDF size: 305.39 Kb.

ABSTRACT

Introduction: since the beginning of blood banks, refinements in laboratory processes have allowed longer red blood cell storage times. While advantageous to the logistics of stock management, the clinical impact of RBC storage duration prior to transfusion remains uncertain and a topic of growing interest. Although the structural, biochemical, and impermeable changes that red blood cells undergo during storage are well described, the evidence that this storage injury translates into adverse clinical outcomes for patients receiving blood with longer storage times remains controversial. Objective: to compare the efficacy of the transfusion of globular packages of ≤ 15 days of extraction vs. globular packages ≥ 16-40 days of extraction in the hemodynamic and gasometric repercussion of patients with severe traumatic brain injury (TBI), hospitalized in the Intensive Care Unit of HE CMNO. Material and methods: a controlled, single-center, randomized, single-blind, prospective and comparative clinical trial was conducted, where patients between 18 and 80 years of age with severe postoperative cranioencephalic trauma who required blood transfusions were invited to participate. Participants were included in two random groups, group F and group E. Group F was administered packed cells ≤ 15 days of extraction. Group E will be administered globular packages ≥ 16-40 days of extraction. During the study, various hemodynamic and biochemical variables were measured before, during, and after blood transfusion, and a comparison of the results obtained between groups F and E was subsequently made. Results: in the present study, a total of 26 patients with severe TBI were included and who were transfused with red blood cell packs, of the total number of patients, 13 were transfused with a "standard" red blood cell pack and another 13 patients with a "fresh" red blood cell pack. The average days of transfusion after extraction were 18 and 14 days for the "standard" and "fresh" packs, respectively (p ≤ 0.001). Twenty-one infectious events were reported, 11 in the group of patients who were transfused with the standard pack and 10 in the fresh pack group. Mortality at 28 days was estimated in 31% of the patients transfused with the standard pack and in 23% of the patients with the fresh pack (RR, for 28-day mortality of 0.90 [95% CI 0.56-144]). The median duration time in the intensive care unit was 8 days for both groups (0.32 SD), and of the days associated with the ventilator, 15 days were observed for the group of patients with the standard package and 7 for the group with fresh package (0.60 SD), without discovering statistically significant differences in these variables. However, in this analysis statistically significant differences were found for the gasometric parameters of central venous oxygen saturation, cardiac output (Fick) and lactate before and after transfusion in favor of the group of patients transfused with fresh pack (p ≤ 0.05). Conclusion: the results of this study infer that there is no association between the storage time of transfused red blood cells and the presence of adverse clinical outcomes with longer storage times. In both groups, transfusions were equally safe and effective. The researchers refer to the sample size as a limitation for this study.

REFERENCES

1. Shapiro MJ. To filter blood or universal leukoreduction: what is the answer? Crit Care. 2004;8 Suppl 2(Suppl 2):S27-S30.

2. Hess JR. An update on solutions for red cell storage. Vox Sang. 2006;91(1):13-19.

3. Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, et al. The CRIT study: anemia and blood transfusion in the critically ill--current clinical practice in the United States. Crit Care Med. 2004;32(1):39-52.

4. Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, et al. Anemia and blood transfusion in critically ill patients. JAMA. 2002;288(12):1499-1507.

5. Rawn J. The silent risks of blood transfusion. Curr Opin Anaesthesiol. 2008;21(5):664-668.

6. Laurie J, Wyncoll D, Harrison C. New versus old blood - the debate continues. Crit Care. 2010;14(2):130.

7. Zallen G, Offner PJ, Moore EE, Blackwell J, Ciesla DJ, Gabriel J, et al. Age of transfused blood is an independent risk factor for postinjury multiple organ failure. Am J Surg. 1999;178(6):570-572.

8. Offner PJ, Moore EE, Biffl WL, Johnson JL, Silliman CC. Increased rate of infection associated with transfusion of old blood after severe injury. Arch Surg. 2002;137(6):711-716; discussion 716-717.

9. Koch CG, Li L, Sessler DI, Figueroa P, Hoeltge GA, Mihaljevic T, et al. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med. 2008;358(12):1229-1239.

10. Weinberg JA, McGwin G Jr, Griffin RL, Huynh VQ, Cherry SA 3rd, Marques MB, et al. Age of transfused blood: an independent predictor of mortality despite universal leukoreduction. J Trauma. 2008;65(2):279-282; discussion 282-284.

11. van de Watering L, Lorinser J, Versteegh M, Westendord R, Brand A. Effects of storage time of red blood cell transfusions on the prognosis of coronary artery bypass graft patients. Transfusion. 2006;46(10):1712-1718.

12. Leal-Noval SR, Jara-López I, García-Garmendia JL, Marín-Niebla A, Herruzo-Avilés A, Camacho-Laraña P, et al. Influence of erythrocyte concentrate storage time on postsurgical morbidity in cardiac surgery patients. Anesthesiology. 2003;98(4):815-822.

13. Yap CH, Lau L, Krishnaswamy M, Gaskell M, Yii M. Age of transfused red cells and early outcomes after cardiac surgery. Ann Thorac Surg. 2008;86(2):554-559.

14. Dessertaine G, Hammer L, Chenais F, Rémy J, Schwebel C, Tabah A, et al. Does red blood cell storage time still influence ICU survival? Transfus Clin Biol. 2008;15(4):154-159.

15. Silliman CC, Clay KL, Thurman GW, Johnson CA, Ambruso DR. Partial characterization of lipids that develop during the routine storage of blood and prime the neutrophil NADPH oxidase. J Lab Clin Med. 1994;124(5):684-694.

16. Hyllner M, Arnestad JP, Bengtson JP, Rydberg L, Bengtsson A. Complement activation during storage of whole blood, red cells, plasma, and buffy coat. Transfusion. 1997;37(3):264-268.

17. Shanwell A, Kristiansson M, Remberger M, Ringdén O. Generation of cytokines in red cell concentrates during storage is prevented by prestorage white cell reduction. Transfusion. 1997;37(7):678-684.

18. Card RT, Mohandas N, Mollison PL. Relationship of post-transfusion viability to deformability of stored red cells. Br J Haematol. 1983;53(2):237-240.

19. Guidet B. Should fresh blood be recommended for intensive care patients? Crit Care. 2010;14:158.

20. Bennett-Guerrero E, Veldman TH, Doctor A, Telen MJ, Ortel TL, Reid TS, et al. Evolution of adverse changes in stored RBCs. Proc Natl Acad Sci U S A. 2007;104(43):17063-17068.

21. Marik PE, Sibbald WJ. Effect of stored-blood transfusion on oxygen delivery in patients with sepsis. JAMA. 1993;269(23):3024-3029.

22. Hao Z, Wu B, Wang D, Lin S, Tao W, Liu M. A cohort study of patients with anemia on admission and fatality after acute ischemic stroke. J Clin Neurosci. 2013;20(1):37-42.

23. Hare GM, Tsui AK, McLaren AT, Ragoonanan TE, Yu J, Mazer CD. Anemia and cerebral outcomes: many questions, fewer answers. Anesth Analg. 2008;107(4):1356-1370.

24. Salim A, Hadjizacharia P, DuBose J, Brown C, Inaba K, Chan L, et al. Role of anemia in traumatic brain injury. J Am Coll Surg. 2008;207(3):398-406.

25. Sekhon MS, McLean N, Henderson WR, Chittock DR, Griesdale DE. Association of hemoglobin concentration and mortality in critically ill patients with severe traumatic brain injury. Crit Care. 2012;16(4):R128.

26. Sahuquillo J, Poca MA, Garnacho A, Robles A, Coello F, Godet C, et al. Early ischaemia after severe head injury. Preliminary results in patients with diffuse brain injuries. Acta Neurochir (Wien). 1993;122(3-4):204-214.

27. Carson JL, Grossman BJ, Kleinman S, Tinmouth AT, Marques MB, Fung MK, et al. Red blood cell transfusion: a clinical practice guideline from the AABB. Ann Intern Med. 2012;157(1):49-58.

28. Marik PE, Corwin HL. Efficacy of red blood cell transfusion in the critically ill: a systematic review of the literature. Crit Care Med. 2008;36(9):2667-2674.

29. Lelubre C, Bouzat P, Crippa IA, Taccone FS. Anemia management after acute brain injury. Crit Care. 2016;20(1):152.

30. Lacroix J, Hébert PC, Fergusson DA, Tinmouth A, Cook DJ, Marshall JC, et al. Age of transfused blood in critically ill adults. N Engl J Med. 2015;372(15):1410-1418.

31. Kor DJ, Kashyap R, Weiskopf RB, Wilson GA, van Buskirk CM, Winters JL, et al. Fresh red blood cell transfusion and short-term pulmonary, immunologic, and coagulation status: a randomized clinical trial. Am J Respir Crit Care Med. 2012;185(8):842-850.

32. Walsh TS, McArdle F, McLellan SA, Maciver C, Maginnis M, Prescott RJ, et al. Does the storage time of transfused red blood cells influence regional or global indexes of tissue oxygenation in anemic critically ill patients? Crit Care Med. 2004;32(2):364-371.

33. Heddle NM, Cook RJ, Arnold DM, Crowther MA, Warkentin TE, Webert KE, et al. The effect of blood storage duration on in-hospital mortality: a randomized controlled pilot feasibility trial. Transfusion. 2012;52(6):1203-1212.

34. Aubron C, Syres G, Nichol A, Bailey M, Board J, Magrin G, et al. A pilot feasibility trial of allocation of freshest available red blood cells versus standard care in critically ill patients. Transfusion. 2012;52(6):1196-1202.

35. van de Watering L; Biomedical Excellence for Safer Transfusion (BEST) Collaborative. Pitfalls in the current published observational literature on the effects of red blood cell storage. Transfusion. 2011;51(8):1847-1854.

36. Hess JR. Red cell changes during storage. Transfus Apher Sci. 2010;43(1):51-59.