Prolonged red cell storage before transfusion increases extravascular hemolysis

Francesca Rapido, Gary M Brittenham, Sheila Bandyopadhyay, Francesca La Carpia, Camilla L'Acqua, Donald J McMahon, Abdelhadi Rebbaa, Boguslaw S Wojczyk, Jane Netterwald, Hangli Wang, Joseph Schwartz, Andrew Eisenberger, Mark Soffing, Randy Yeh, Chaitanya Divgi, Yelena Z Ginzburg, Beth H Shaz, Sujit Sheth, Richard O Francis, Steven L SpitalnikEldad A Hod

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Some countries have limited the maximum allowable storage duration for red cells to 5 weeks before transfusion. In the US, red blood cells can be stored for up to 6 weeks, but randomized trials have not assessed the effects of this final week of storage on clinical outcomes.

METHODS: Sixty healthy adult volunteers were randomized to a single standard, autologous, leukoreduced, packed red cell transfusion after 1, 2, 3, 4, 5, or 6 weeks of storage (n = 10 per group). 51-Chromium posttransfusion red cell recovery studies were performed and laboratory parameters measured before and at defined times after transfusion.

RESULTS: Extravascular hemolysis after transfusion progressively increased with increasing storage time (P < 0.001 for linear trend in the AUC of serum indirect bilirubin and iron levels). Longer storage duration was associated with decreasing posttransfusion red cell recovery (P = 0.002), decreasing elevations in hematocrit (P = 0.02), and increasing serum ferritin (P < 0.0001). After 6 weeks of refrigerated storage, transfusion was followed by increases in AUC for serum iron (P < 0.01), transferrin saturation (P < 0.001), and nontransferrin-bound iron (P < 0.001) as compared with transfusion after 1 to 5 weeks of storage.

CONCLUSIONS: After 6 weeks of refrigerated storage, transfusion of autologous red cells to healthy human volunteers increased extravascular hemolysis, saturated serum transferrin, and produced circulating nontransferrin-bound iron. These outcomes, associated with increased risks of harm, provide evidence that the maximal allowable red cell storage duration should be reduced to the minimum sustainable by the blood supply, with 35 days as an attainable goal.REGISTRATION. ClinicalTrials.gov NCT02087514.

FUNDING: NIH grant HL115557 and UL1 TR000040.

Original languageEnglish
Pages (from-to)375-382
Number of pages8
JournalJournal of Clinical Investigation
Volume127
Issue number1
DOIs
Publication statusPublished - Jan 3 2017

Keywords

  • Adolescent
  • Adult
  • Aged
  • Blood Preservation
  • Erythrocyte Transfusion
  • Erythrocytes
  • Female
  • Hemolysis
  • Humans
  • Iron
  • Male
  • Middle Aged
  • Time Factors
  • Comparative Study
  • Journal Article
  • Multicenter Study
  • Randomized Controlled Trial

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  • Cite this

    Rapido, F., Brittenham, G. M., Bandyopadhyay, S., La Carpia, F., L'Acqua, C., McMahon, D. J., Rebbaa, A., Wojczyk, B. S., Netterwald, J., Wang, H., Schwartz, J., Eisenberger, A., Soffing, M., Yeh, R., Divgi, C., Ginzburg, Y. Z., Shaz, B. H., Sheth, S., Francis, R. O., ... Hod, E. A. (2017). Prolonged red cell storage before transfusion increases extravascular hemolysis. Journal of Clinical Investigation, 127(1), 375-382. https://doi.org/10.1172/JCI90837