Transfusion of Red Blood Cells with Different Duration for Patients' Prognosis: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 JINXing , MAHan-ping , WANGJiang ,  ZHENGHong

Department of Anesthesia, The First Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding author：

ZHENGHong, Email: xyzhenghong@yahoo.com.cn

Keywords：

Red cell storage lesion; Blood transfusion; Prognosis; Systematic review; Meta-analysis; Case-control study; Cohort study

DOI：

10.7507/1672-2531.20140052

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review transfusion of red blood cells with different duration for patients' prognosis so as to provide evidence for the reasonable blood use in clinic. Methods Databases including The Cochrane Library (Issue 3, 2013), PubMed, Ovid, EMbase, WanFang Data and CNKI were electrically searched to collect studies published from 2002 to 2013, and relevant periodicals and references of the included studies were also manually retrieved. According to the inclusion and exclusion criteria, related studies were screened, data were extracted, and the quality of included studies was evaluated by two reviewers independently. Then meta-analysis was conducted using RevMan 5.0 software. Results A total of 10 studies (including 4 case-control studies and 6 cohort studies) were included, involving 15 187 patients. The results of meta-analysis revealed that, transfusion of fresh red cells (≤10-18 days) was superior to that of old ones ( > 14-28 days) in decreasing the short-term mortality (OR=0.69, 95%CI 0.58 to 0.82, P < 0.000 1) and the incidence of hospital infection (OR=0.67, 95%CI 0.55 to 0.81, P < 0.000 1), and in decreasing the incidences of post-operation kidney failure (OR=0.52 95%CI 0.37 to 0.73, P=0.000 2) and prolonged ventilatory support ( > 72 h) (OR=0.54 95%CI 0.45 to 0.66, P < 0.000 01) for patients with cardiac surgery, all with significant differences. Conclusion Transfusion of fresh red cells (≤10-18 days) is superior to that of old ones ( > 14-28 days) in decreasing the short-term mortality and the incidence of hospital infection, and in decreasing the incidences of post-operation kidney failure and prolonged ventilatory support ( > 72 h) for patients with cardiac surgery, which improve prognosis. Due to the limited quality and quantity of the included studies, the aforementioned conclusion needs to be verified by conducting more high quality studies.

Citation： JINXing, MAHan-ping, WANGJiang, ZHENGHong. Transfusion of Red Blood Cells with Different Duration for Patients' Prognosis: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2014, 14(3): 299-305. doi: 10.7507/1672-2531.20140052 Copy

1.	World Health Organization. Global database on blood safety:report 2004-2005. Geneva, Switzerland:World:Health Organization. 2008.
2.	Vandromme MJ, McGwin G Jr, Weinberg JA. Blood transfusion in the critically ill:does storage age matter? Scand J Trauma Resusc Emerg Med, 2009, 17:35.
3.	Grimshaw K, Sahler J, Spinelli SL, et al. New frontiers in transfusion biology:identification and significance of mediators of morbidity and mortality in stored red blood cells. Transfusion, 2011, 51(4):874-880.
4.	Wells GA, Shea B, O'Connell D. Newcastle-Ottawa scale. 2006. Available at:http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.
5.	Koch CG, Li L, Sessler DI, et al. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med, 2008, 358(12):1229-1239.
6.	van de Watering L, Lorinser J, Versteegh M, et al. Effects of storage time of red blood cell transfusions on the prognosis of coronary artery bypass graft patients. Transfusion, 2006, 46(10):1712-1718.
7.	van Straten AH, Soliman Hamad MA, van Zundert AA, et al. Effect of duration of red blood cell storage on early and late mortality after coronary artery bypass grafting. J Thorac Cardiovasc Surg, 2011, 141(1):231-237.
8.	Andreasen JJ, Dethlefsen C, Modrau IS, et al. Storage time of allogeneic red blood cells is associated with risk of severe postoperative infection after coronary artery bypass grafting. Eur J Cardiothorac Surg, 201139(3):329-334.
9.	Hébert PC, Chin-Yee I, Fergusson D, et al. A pilot trial evaluating the clinical effects of prolonged storage of red cells. Anesth Analg, 2005, 100(5):1433-1438,.
10.	Sanders J, Patel S, Cooper J, et al. Red blood cell storage is associated with length of stay and renal complications after cardiac surgery. Transfusion, 2011, 51(11):2286-2294.
11.	Leal-Noval SR, Munoz-Gomez M, Arellano-Orden V, et al. Impact of age of transfused blood on cerebral oxygenation in male patients with severe traumatic brain injury. Crit Care Med, 2008, 36(4):1290-1296.
12.	Pettila V, Westbrook AJ, Nichol AD, et al. Blood Observational Study Investigators for ANZICS Clinical Trials Group. Age of red blood cells and mortality in the critically ill. Crit Care, 2011, 15(2):R116.
13.	Kaukonen KM, Vaara ST, Pettila V, et al. Age of red blood cells and outcome in acute kidney injury. Crit Care, 2013, 17(5):R222.
14.	McKenny M, Ryan T, Tate H, et al. Age of transfused blood is not associated with increased postoperative adverse outcome after cardiac surgery. Br J Anaesth, 2011, 106(5):643-649.
15.	Aubron C, Nichol A, Cooper DJ, et al. Age of red cells and transfusion in critically ill patients. Ann Intensive Care, 2013, 13(1):2.
16.	Donadee C, Raat NJ, Kanias T, et al. Nitric oxide scavenging by red blood cell microparticles and cell-free hemoglobin as a mechanism for the red cell storage lesion. Circulation, 2011, 124(4):465-476.
17.	Stapley R, Owusu BY, Brandon A, et al. Erythrocyte storage increases rates of NO and nitrite scavenging:implications for transfusionrelated toxicity. Biochem J, 2012, 446(3):499-508.
18.	李遥金, 王翔, 兰珂.血液保存对红细胞携氧功能及能量代谢的影响.中国输血杂志, 2009, 22(6):439-443.
19.	Raghavan M, Marik PE. Anemia, allogeneic blood transfusion, and immunomodulation in the critically ill. Chest, 2005, 127(1):295-307.
20.	Long k, Meier C, Bernard A, et al. T-cell suppression by red blood cells is dependent on intact cells and is a consequence of blood bank processing. Transfusion, 2013, 4:1-8.
21.	Baek JH, D'Agnillo F, Vallelian F, et al. Hemoglobin-driven pathophysiology is an in vivo consequence of the red blood cell storage lesion that can be attenuated in guinea pigs by haptoglobin therapy. J Clin Invest. 2012, 122(4):1444-1458.
22.	Rao RS, Howard CA, Teague TK. Pulmonary endothelial permeability is increased by fluid from packed red blood cell units but not by fluid from clinically-available washed units. J Trauma, 2006, 60(4):851-858.
23.	Vlaar AP, Hofstra JJ, Levi M, et al. Supernatant of aged erythrocytes causes lung inflammation and coagulopathy in a "two-hit" in vivo syngeneic transfusion model. Anesthesiology, 2010, 113(1):92-103.
24.	Tran A, Yang D, Bonilla A, et al. Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery. Can J Anaesth, 2013, 60(8):761-70.
25.	Berra L, Coppadoro A, Yu B, et al. Transfusion of stored autologous blood does not alter reactive hyperemia index in healthy volunteers. Anesthsiology, 2012, 117(1):56-63.

1. World Health Organization. Global database on blood safety:report 2004-2005. Geneva, Switzerland:World:Health Organization. 2008.
2. Vandromme MJ, McGwin G Jr, Weinberg JA. Blood transfusion in the critically ill:does storage age matter? Scand J Trauma Resusc Emerg Med, 2009, 17:35.
3. Grimshaw K, Sahler J, Spinelli SL, et al. New frontiers in transfusion biology:identification and significance of mediators of morbidity and mortality in stored red blood cells. Transfusion, 2011, 51(4):874-880.
4. Wells GA, Shea B, O'Connell D. Newcastle-Ottawa scale. 2006. Available at:http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.
5. Koch CG, Li L, Sessler DI, et al. Duration of red-cell storage and complications after cardiac surgery. N Engl J Med, 2008, 358(12):1229-1239.
6. van de Watering L, Lorinser J, Versteegh M, et al. Effects of storage time of red blood cell transfusions on the prognosis of coronary artery bypass graft patients. Transfusion, 2006, 46(10):1712-1718.
7. van Straten AH, Soliman Hamad MA, van Zundert AA, et al. Effect of duration of red blood cell storage on early and late mortality after coronary artery bypass grafting. J Thorac Cardiovasc Surg, 2011, 141(1):231-237.
8. Andreasen JJ, Dethlefsen C, Modrau IS, et al. Storage time of allogeneic red blood cells is associated with risk of severe postoperative infection after coronary artery bypass grafting. Eur J Cardiothorac Surg, 201139(3):329-334.
9. Hébert PC, Chin-Yee I, Fergusson D, et al. A pilot trial evaluating the clinical effects of prolonged storage of red cells. Anesth Analg, 2005, 100(5):1433-1438,.
10. Sanders J, Patel S, Cooper J, et al. Red blood cell storage is associated with length of stay and renal complications after cardiac surgery. Transfusion, 2011, 51(11):2286-2294.
11. Leal-Noval SR, Munoz-Gomez M, Arellano-Orden V, et al. Impact of age of transfused blood on cerebral oxygenation in male patients with severe traumatic brain injury. Crit Care Med, 2008, 36(4):1290-1296.
12. Pettila V, Westbrook AJ, Nichol AD, et al. Blood Observational Study Investigators for ANZICS Clinical Trials Group. Age of red blood cells and mortality in the critically ill. Crit Care, 2011, 15(2):R116.
13. Kaukonen KM, Vaara ST, Pettila V, et al. Age of red blood cells and outcome in acute kidney injury. Crit Care, 2013, 17(5):R222.
14. McKenny M, Ryan T, Tate H, et al. Age of transfused blood is not associated with increased postoperative adverse outcome after cardiac surgery. Br J Anaesth, 2011, 106(5):643-649.
15. Aubron C, Nichol A, Cooper DJ, et al. Age of red cells and transfusion in critically ill patients. Ann Intensive Care, 2013, 13(1):2.
16. Donadee C, Raat NJ, Kanias T, et al. Nitric oxide scavenging by red blood cell microparticles and cell-free hemoglobin as a mechanism for the red cell storage lesion. Circulation, 2011, 124(4):465-476.
17. Stapley R, Owusu BY, Brandon A, et al. Erythrocyte storage increases rates of NO and nitrite scavenging:implications for transfusionrelated toxicity. Biochem J, 2012, 446(3):499-508.
18. 李遥金, 王翔, 兰珂.血液保存对红细胞携氧功能及能量代谢的影响.中国输血杂志, 2009, 22(6):439-443.
19. Raghavan M, Marik PE. Anemia, allogeneic blood transfusion, and immunomodulation in the critically ill. Chest, 2005, 127(1):295-307.
20. Long k, Meier C, Bernard A, et al. T-cell suppression by red blood cells is dependent on intact cells and is a consequence of blood bank processing. Transfusion, 2013, 4:1-8.
21. Baek JH, D'Agnillo F, Vallelian F, et al. Hemoglobin-driven pathophysiology is an in vivo consequence of the red blood cell storage lesion that can be attenuated in guinea pigs by haptoglobin therapy. J Clin Invest. 2012, 122(4):1444-1458.
22. Rao RS, Howard CA, Teague TK. Pulmonary endothelial permeability is increased by fluid from packed red blood cell units but not by fluid from clinically-available washed units. J Trauma, 2006, 60(4):851-858.
23. Vlaar AP, Hofstra JJ, Levi M, et al. Supernatant of aged erythrocytes causes lung inflammation and coagulopathy in a "two-hit" in vivo syngeneic transfusion model. Anesthesiology, 2010, 113(1):92-103.
24. Tran A, Yang D, Bonilla A, et al. Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery. Can J Anaesth, 2013, 60(8):761-70.
25. Berra L, Coppadoro A, Yu B, et al. Transfusion of stored autologous blood does not alter reactive hyperemia index in healthy volunteers. Anesthsiology, 2012, 117(1):56-63.

Chinese Journal of Evidence-Based Medicine

Transfusion of Red Blood Cells with Different Duration for Patients' Prognosis: A Meta-Analysis

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