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Red blood cell storage duration is associated with various clinical outcomes in pediatric cardiac surgery
Matthias Redlin1, Helmut Habazettl2, Helge Schoenfeld3
1Department of Anesthesiology, German Heart Institute, Charité University Medicine Berlin, Berlin, Germany.
Insights
Transfusing fresher red blood cells (RBCs) within 4 days may reduce transfusion needs in pediatric cardiac surgery. Storage longer than 6 days is linked to increased postoperative morbidity, suggesting benefits of using fresh RBCs.
Area of Science:
- Pediatric Cardiac Surgery
- Transfusion Medicine
- Hematology
Background:
- Limited evidence exists on optimal red blood cell (RBC) storage duration for pediatric cardiac surgery patients.
- The ideal storage time cut-off for fresh RBC units remains undetermined.
Purpose of the Study:
- To determine the optimal storage time for red blood cells (RBCs) in pediatric cardiac surgery.
- To evaluate the association between RBC storage duration and transfusion requirements and postoperative outcomes.
Main Methods:
- Analysis of data from 139 pediatric patients undergoing cardiac surgery who received RBCs within 14 days of storage.
- Multivariate analyses were performed to identify optimal RBC storage time cut-offs for various outcome parameters.
Main Results:
- Patients receiving RBCs stored for 4-14 days required more RBC and fresh frozen plasma (FFP) transfusions compared to those receiving RBCs stored ≤3 days.
- Increased RBC storage time correlated with higher odds of FFP administration.
- Optimal cut-offs for reduced postoperative morbidity were ≤6 days for ventilation duration and C-reactive protein (CRP) levels.
Conclusions:
- Increasing RBC storage time is associated with increased transfusion hazards.
- Transfusing fresh RBCs stored ≤2 or 4 days may benefit transfusion requirements.
- Using RBCs stored ≤6 days might reduce postoperative morbidity in pediatric cardiac surgery patients, warranting further research.
Background:
Recommendations on the use of fresh red blood cells (RBCs) in pediatric patients undergoing cardiac surgery are based on limited information. Furthermore, the RBC storage time cut-off of fresh units remains unknown.
Methods:
Data from 139 pediatric patients who underwent cardiac surgery and received RBCs from a single unit within 14 days of storage were analyzed. To identify the optimal cut-off storage time of RBCs for transfusion, multiple multivariate analyses aimed at different outcome parameters were performed.
Results:
26 patients received RBC units stored for ≤3 days, while 126 patients received RBCs that were stored for 4-14 days. The latter group required more RBC transfusions and fresh frozen plasma (FFP) than the former group (19 vs. 25 ml/kg, p = 0.003 and 73% vs. 35%, p = 0.0006, respectively). In addition, the odds for the administration of FFP increased with the transfusion of RBCs stored for more than 4 days. The optimal cut-off for post-operative morbidity was observed with a storage time of ≤6 days for length of ventilation (p = 0.02) and peak of C-reactive protein (CRP; p = 0.008).
Conclusions:
The obtained results indicate that the hazard of blood transfusion increased with increasing storage time of RBCs. The results of this study suggest that transfusion of fresh RBCs with a storage time of ≤2 or 4 days (concerning transfusion requirements) or ≤6 days (concerning postoperative morbidity) may be beneficial in pediatric patients undergoing cardiac surgery. However, further prospective randomized studies are required in order to draw any final conclusions.
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