Age of blood: does older blood yield poorer outcomes?

Possible adverse effects of prolonged storage of red blood cell concentrates (RBCs) are being formally assessed both by observational studies and in randomized controlled trials. New mechanisms have been put forth to explain earlier conflicting observations. This review summarizes ongoing investigations into clinical and basic science studies on RBC storage effects.

Research into possible deleterious clinical effects of prolonged storage of RBCs has explored the contribution of various RBC production aspects (e.g. overnight hold, centrifugation speed, storage solution), seldom previously reported. Other studies investigated putative underlying mechanisms like free iron, inflammation, cytokines, and so on. Many publications include multiple analyses, like different cut-off values for 'old', or taking into account both oldest and average RBC storage time. Also, more studies correct for possible confounding effects to get a better estimate of associations. An alarming and ironic observation is that several studies found higher risks with fresh RBCs after correction for confounding. The results from the first large randomized controlled trials show no differences between old and fresh RBCs.

We still do not know whether older red cells have adverse effects, and if so, what determines such clinical effects after transfusion of 'old' RBCs. RBC production factors, previously seldom reported, may play an important role and should be reported.