Massive transfusion protocol activation does not result in preferential use of older red blood cells.

Lauren M Mcdaniel,Matthew D Neal,James Cramer,Jay S Raval,Brian S Zuckerbraun,Darrell J Triulzi,Andrew B Peitzman,Jason L Sperry

doi:10.1155/2014/328967

Abstract

Widespread, anecdotal belief exists that patients receiving massive transfusion, particularly those for whom a massive transfusion protocol (MTP) is activated, are more likely to receive older red blood cells (RBCs). Retrospective review of blood bank records from calendar year 2011 identified 131 patients emergently issued ≥10 RBC units (emergency release (ER)) prior to obtaining a type and screen. This cohort was subclassified based on whether there was MTP activation. For comparison, 176 identified patients transfused with ≥10 RBC units in a routine fashion over 24 hours represented the nonemergency release (nER) cohort. Though the median age of ER RBCs was 5 days older than nER RBCs (ER 20, nER 15 days, P < 0.001), both fell within the third week of storage. Regardless of MTP activation, transfused ER RBCs had the same median age (MTP 20, no-MTP 20 days, P = 0.069). In the ER cohort, transition to type-specific blood components increased the median age of transfused RBC units from 17 to 36 days (P < 0.001). These data refute the anecdotal belief that MTP activation results in transfusion of older RBCs. However, upon transition to type-specific blood components, the age of RBCs enters a range in which it is hypothesized that there may be a significant effect of storage age on clinical outcomes.

Highlights

The influence of duration of storage of red blood cells (RBCs) on clinical outcomes is currently unknown
Regardless of whether RBCs were requested with or without massive transfusion protocol (MTP) activation, the median ages of transfused units between the two subgroups were identical with similar interquartile ranges (MTP 20 [IQR 12, 29], nMTP 20 [IQR 13, 31], P = 0.069) (Figure 2)
We demonstrate that RBC units issued to massively transfused patients within our large tertiary referral center in either an emergent or nonemergent fashion have ages that fall within the same week of storage

Summary

Introduction

The influence of duration of storage of red blood cells (RBCs) on clinical outcomes is currently unknown. Most blood banks in the United States practice a “first-in-first-out” inventory policy, which could potentially result in the delivery of large volumes of older RBCs to massively hemorrhaging patients [11,12,13]. Despite the concern regarding the age of RBCs transfused to patients with massive hemorrhage, there are no studies designed to address whether the use of a massive transfusion protocol (MTP) results in the delivery of older RBCs. studies exist to suggest that certain ABO blood types may be stored for longer duration due to infrequent use [11, 13], there is no data to suggest how ABO blood type impacts the age of RBCs given in massive transfusion. We hypothesized that MTP activation would not result in the transfusion of older RBCs

Objectives

Methods

Results

Conclusion