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Blood's Shelf Life May Be as Short as 3 Weeks

 |  By cclark@healthleadersmedia.com  
   March 05, 2013

A small study of how blood ages in storage, and after being transfused in patients who underwent spinal fusion surgery suggests a worrisome finding for the world's blood banking industry, hospitals and transfused patients:  Blood stored longer than 21 days appears to stiffen, making it less able to squeeze into small capillaries and organs that need it.

Current day practice allows the use of blood up to six weeks after it is collected but if the current study's findings hold up in larger studies now underway, blood banks throughout the country would have to consider throwing out blood older than 21 days and shortening its shelf life.

"They'll lose a huge portion of their blood inventory," says Steven M. Frank, MD, the study's author and associate professor of anesthesiology and critical care medicine at Johns Hopkins University School of Medicine.

"This is one more piece to the puzzle suggesting that older, stored red blood cells are not as functional as fresher ones,"  he says, and it's making blood banking organizations like the Red Cross "really nervous."

The study by Frank and colleagues at Johns Hopkins is published in Anesthesia & Analgesia, the journal of the International Anesthesia Research Society.

First In, First Out
Frank adds that throughout the country, blood bank practices direct "first in, first out" policies, so that the oldest stored blood is used first, "because no one wants the blood to expire." According to rules set by the U.S. Food and Drug Administration, after 42 days, or six weeks after it is donated, blood may not be transfused.

With four to five million patients receiving transfusions in the United States each year, transfusing blood is arguably the most common procedure in healthcare. 

The finding is also worrisome because with many more uses for blood, an aging population more likely to need it and less likely to donate it, putting the nation at risk for even worse blood shortage. Barriers to blood donation include certain medical conditions and prescription drugs.

The finding also could impact where and how blood is transported and marketed. Hospitals may be located significant travel distances from the blood banks that collect and distribute blood.

Damage to Cells
In Frank's experiment, six of the 16 patients received at least five units of blood while 10 received fewer than four.  Frank's team took samples from every bag of blood and then measured the flexibility of the outer membrane of the red cell, and discovered the lack of  "deformability," the ability of the cells to squeeze into small diameter capillaries.

They also measured samples of the patients' blood three days after surgery, and found that the damage had not reversed itself. It appeared the cells would remain dysfunctional.

James AuBuchon, MD, former president of the AABB (formerly the American Association of Blood Banks, says, however,  that the report is not news. "We've known [for decades] that red cells become stiffer. And there are myriad changes that occur during red cell storage; I can probably list 30 of them. But which ones have any clinical impact is not known."

Watch and Wait
He added that the results of Frank's paper, which examined changes in blood in only 16 patients, "should not be the basis for changing clinical practices at this point."

Frank agrees. Both he and AuBuchon say the nation's hematology community awaits the results of two important studies comparing a number of major outcomes in patients who received transfused blood that was stored longer and those whose transfused blood was stored for just a few days.

Those trials are RECESS and ABLE.  RECESS (Red Cell storage Duration Study) funded by the National Heart, Lung, and Blood Institute, a multi-center trial looking at mortality, multiple organ dysfunction, post-operative complications such as cardiac or pulmonary events in patients transfused with blood older than 20 days versus units stored less than 11 days.

ABLE (Age of Blood Evaluation study) funded by the National Institute for Health Research in Canada, a double-blind, multicenter, parallel randomized controlled clinical trial. It will compare transfused blood stored for 7 days or less (the fresh arm), with blood stored on average between 15 and 20 days (the control arm) with an eye to comparing 90-day morbidity and mortality in critically ill patients treated in hospital intensive care units.

The results of ARIPI, (Age of Red Blood Cells In Premature Infants), results were published in the Journal of the American Medical Association Feb. 13, andfound no outcome differences in patients who received blood stored for seven days versus 14 days.

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