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Effect of Fresh vs Standard-issue Red Blood Cell Transfusions on Multiple Organ Dysfunction Syndrome in Critically
Philip C Spinella1, Marisa Tucci2, Dean A Fergusson3
1Division of Critical Care, Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri.
Insights
Transfusing fresh red blood cells (stored ≤7 days) did not reduce new or progressive multiple organ dysfunction syndrome in critically ill children compared to standard-issue red blood cells. This large randomized trial found no significant difference in outcomes or mortality.
Area of Science:
- Pediatric critical care medicine
- Transfusion medicine
- Hematology
Background:
- The clinical impact of red blood cell storage duration on critically ill pediatric patients remains under-investigated.
- Previous studies have not provided definitive evidence from large-scale randomized trials.
Purpose of the Study:
- To ascertain if transfusing fresh red blood cells (stored ≤7 days) decreases new or progressive multiple organ dysfunction syndrome (MODS) in critically ill children.
- To compare outcomes between fresh and standard-issue red blood cell transfusions in this vulnerable population.
Main Methods:
- The Age of Transfused Blood in Critically-Ill Children trial was a multicenter, blinded, randomized clinical trial involving 1538 pediatric patients.
- Patients received either fresh (≤7 days storage) or standard-issue red blood cells.
- The primary outcome was new or progressive MODS within 28 days or until discharge/death.
Main Results:
- No significant difference was observed in new or progressive MODS between the fresh (20.2%) and standard-issue (18.2%) red blood cell groups.
- Rates of sepsis, acute respiratory distress syndrome, and intensive care unit mortality were similar between the two groups.
- The median storage duration differed significantly (5 days vs. 18 days, P < .001).
Conclusions:
- The use of fresh red blood cells does not appear to reduce the incidence of new or progressive MODS in critically ill pediatric patients.
- Findings suggest that standard-issue red blood cells are a viable option, with no significant difference in major adverse outcomes.
- Further research may explore specific subgroups or alternative interventions for optimizing transfusion strategies in pediatric critical care.
Importance:
The clinical consequences of red blood cell storage age for critically ill pediatric patients have not been examined in a large, randomized clinical trial.
Objective:
To determine if the transfusion of fresh red blood cells (stored ≤7 days) reduced new or progressive multiple organ dysfunction syndrome compared with the use of standard-issue red blood cells in critically ill children.
Design, Setting, And Participants:
The Age of Transfused Blood in Critically-Ill Children trial was an international, multicenter, blinded, randomized clinical trial, performed between February 2014 and November 2018 in 50 tertiary care centers. Pediatric patients between the ages of 3 days and 16 years were eligible if the first red blood cell transfusion was administered within 7 days of intensive care unit admission. A total of 15 568 patients were screened, and 13 308 were excluded.
Interventions:
Patients were randomized to receive either fresh or standard-issue red blood cells. A total of 1538 patients were randomized with 768 patients in the fresh red blood cell group and 770 in the standard-issue group.
Main Outcomes And Measures:
The primary outcome measure was new or progressive multiple organ dysfunction syndrome, measured for 28 days or to discharge or death.
Results:
Among 1538 patients who were randomized, 1461 patients (95%) were included in the primary analysis (median age, 1.8 years; 47.3% girls), in which there were 728 patients randomized to the fresh red blood cell group and 733 to the standard-issue group. The median storage duration was 5 days (interquartile range [IQR], 4-6 days) in the fresh group vs 18 days (IQR, 12-25 days) in the standard-issue group (P < .001). There were no significant differences in new or progressive multiple organ dysfunction syndrome between fresh (147 of 728 [20.2%]) and standard-issue red blood cell groups (133 of 732 [18.2%]), with an unadjusted absolute risk difference of 2.0% (95% CI, -2.0% to 6.1%; P = .33). The prevalence of sepsis was 25.8% (160 of 619) in the fresh group and 25.3% (154 of 608) in the standard-issue group. The prevalence of acute respiratory distress syndrome was 6.6% (41 of 619) in the fresh group and 4.8% (29 of 608) in the standard-issue group. Intensive care unit mortality was 4.5% (33 of 728) in the fresh group vs 3.5 % (26 of 732) in the standard-issue group (P = .34).
Conclusions And Relevance:
Among critically ill pediatric patients, the use of fresh red blood cells did not reduce the incidence of new or progressive multiple organ dysfunction syndrome (including mortality) compared with standard-issue red blood cells.
Trial Registration:
ClinicalTrials.gov Identifier: NCT01977547.
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