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The influence of the storage lesion(s) on pediatric red cell transfusion
Kenneth E Remy1, Charles Natanson, Harvey G Klein
1aDepartment of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri bClinical Center, Critical Care Medicine Department cClinical Center, Department of Transfusion Medicine, The National Institutes of Health, Bethesda, Maryland, USA.
Insights
Using older red blood cells (RBCs) for transfusions in children yields inconsistent outcomes. Further research is needed to understand potential risks associated with prolonged storage of RBCs in pediatric patients.
Area of Science:
- Pediatric Hematology
- Transfusion Medicine
- Critical Care
Background:
- Prolonged storage of red blood cells (RBCs) may alter their properties.
- The safety and efficacy of using older RBCs in pediatric patients remain under investigation.
Purpose of the Study:
- To analyze and evaluate current evidence on the use of older, longer-stored RBCs in pediatric transfusions.
- To examine postulated mechanisms of injury from prolonged RBC storage.
- To review clinical outcomes in pediatric patients receiving older RBCs.
Main Methods:
- Review of three randomized controlled trials and seven observational studies.
- Focus on studies conducted exclusively in pediatric populations.
- Analysis of outcomes including mortality, morbidity, and specific conditions like necrotizing enterocolitis.
Main Results:
- Clinical outcomes in pediatric patients receiving older RBCs have been inconsistent.
- Studies reported varied results regarding mortality and morbidity in critically ill children, those undergoing cardiac surgery, and premature infants with necrotizing enterocolitis.
- Many studies were confounded by design, patient heterogeneity, and RBC preparation methods.
Conclusions:
- Further research is warranted to explore potential deleterious effects of older RBC transfusions in diverse pediatric populations.
- Understanding the mechanisms of injury is crucial for interpreting clinical findings and guiding transfusion practices.
Purpose Of Review:
This article will analyze and evaluate the current evidence regarding the use of older, longer-stored red blood cells (RBCs) for transfusion in pediatric patients and will examine some of the postulated mechanisms of injury related to prolonged refrigerated storage of RBCs and studies reporting clinical outcomes.
Recent Findings:
Three randomized controlled trials and seven observational studies have been conducted entirely in pediatric patients. The outcomes, mortality and morbidity in critically ill patients and children undergoing cardiac surgery, and necrotizing enterocolitis in premature infants, have been inconsistent. However, many of these studies have been confounded by study design, mixed patient populations, red cell preparation, and other factors.
Summary:
Further exploration into the possible deleterious effects of older, longer-stored RBC transfusions on mortality and morbidity in different pediatric populations is merited. Understanding the potential mechanisms of injury should help explain the clinical findings.
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