Fresh blood for transfusion in adults with beta thalassaemia

Patients with beta-thalassaemia major require life-long blood transfusion with the aim of achieving normal growth and development whilst minimising iron overload. A pre-transfusion Hb between 9.5 and 10 g/dL is thought to achieve this balance. UK consensus is that fresh blood (less than 14 days) is better at maintaining this target pre-transfusion Hb but there is no firm stipulation in place and no robust evidence supporting this.

After introduction of a universal fresh blood policy for adult beta-thalassaemics in 2010, we reviewed locally transfused adult patients to determine if there was any significant difference in pre-transfusion Hb using fresh blood. Nine adult thalassaemic patients were analysed for two consecutive 6-month periods in 2009 and 2010 (periods 1 and 2).

Mean pre-transfusion Hb was significantly higher by an average of 0.5 g/dL in period 2 than period 1 (P < 0.05). The average unit age was 18 vs 9.5 days for periods 1 and 2 respectively (P < 0.05). There were no significant differences in potential confounders such as transfusion volume (P = 0.06), number of units transfused, ferritin or transfusion interval.

Use of fresh blood produced significantly higher pre-transfusion Hb, giving credence to UK consensus. Lesser volumes of fresh blood appeared to achieve the target pre-transfusion Hb, which may translate to reduced iron overload and chelation costs. Whether the assumption that the use of blood less than 7 days old in these patients would result in greater benefit requires further study.