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Red blood cell storage duration and trauma.
1Department of Immunology, Monash University, Melbourne, Victoria, Australia.
Transfusion Medicine Reviews
|January 10, 2015
Summary
Transfusing older red blood cells (RBCs) may worsen outcomes for trauma patients. Research is needed to understand if stored RBCs exacerbate trauma-induced issues in critically injured patients.
Area of Science:
- Transfusion Medicine
- Trauma Care
- Hematology
Background:
- Retrospective studies link longer red blood cell (RBC) storage to adverse outcomes in trauma, ICU, and cardiac surgery patients.
- Major trauma causes significant hemodynamic and cellular changes in patients' RBCs, increasing risks of hypoxia, coagulopathy, and organ failure.
- Stored RBCs share biophysical characteristics with trauma-stressed RBCs, raising concerns about exacerbating patient conditions.
Purpose of the Study:
- To review nonrandomized studies on red blood cell (RBC) storage duration and clinical outcomes in trauma patients.
- To provide rationale for further research specifically investigating RBC storage duration in the trauma setting.
- To address the gap in randomized controlled trials focusing on trauma patients with hemorrhage.
Main Methods:
- Review of recent nonrandomized studies examining the relationship between RBC storage duration and clinical outcomes in trauma patients.
- Analysis of existing literature on the effects of major trauma on patient RBCs and inflammatory responses.
- Comparison of biophysical characteristics of stored RBCs with trauma-induced RBC changes.
Main Results:
- Nonrandomized studies suggest a potential association between longer RBC storage duration and poorer outcomes in trauma patients.
- Trauma induces RBC rigidity, microvascular flow alterations, and reduced RBC survival, mirroring some storage lesion effects.
- The impact of transfusing stored RBCs on trauma-induced hemodynamic instability remains largely unknown.
Conclusions:
- Further research, including randomized controlled trials, is crucial to determine the safety and efficacy of RBC storage duration in trauma patients.
- Understanding the interaction between stored RBCs and the trauma-induced "storage lesion" in patient RBCs is critical for optimizing transfusion strategies.
- Current evidence from nonrandomized studies highlights the need for dedicated research in this vulnerable patient population.
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