MedicalResearch.com Interview with:
Dr. Walter H. Dzik MD
Associate Pathologist, Massachusetts General Hospital
Associate Professor of Pathology
Harvard Medical School
Medical Research: What is the background for this study? What are the main findings?
Dr. Dzik: Millions of Red Blood Cell transfusions are given each year. To maintain adequate blood inventories worldwide, Red Blood Cell units are stored under refrigerated conditions. Previous animal and laboratory research has highlighted the fact that red cells undergo biochemical, morphologic, and biophysical changes during prolonged refrigerated blood storage. Researchers and clnicians have questioned whether the changes that occur during storage would impair the ability of transfused Red Cells to delivery oxygen to tissues.
Our study was a randomized controlled trial conducted in patients with extreme anemia and insufficient global tissue oxygenation. We randomly assigned children with severe anemia and lactic acidosis to receive Red Blood Cells stored 1-10 days versus Red Blood Cells stored 25-35 days. We measured the recovery from lactic acidosis in response to transfusion in the two groups. We also measured cerebral tissue oxygenation using a non-invasive tissue oximeter. We found that the proportion of patients who achieved reversal of lactic acidosis was the same in the two RBC storage-duration groups. The rate of decline of lactic acidosis was also equal. There was also no difference in cerebral oxygenation, resolution of acidosis, correction of vital signs, clinical recovery, survival and 30-day followup.
Medical Research: What should clinicians and patients take away from your report?
Dr. Dzik: The main message of our work is that the duration of refrigerated storage does NOT impair the delivery of oxygen to tissues by transfused Red Blood Cells. This is good news for patients and for healthcare systems. For patients, the message is that stored RBCs (as are commonly used) “work” just as well as “fresh blood”. For healthcare systems the message is that, seen from the perspective of “efficacy” (oxygen delivery), there is no reason to reduce the shelf-life of Red Blood Cells. This latter conclusion is especially important for areas of the world where blood is in short supply and storage duration is essential to maintain adequate blood inventories.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Dzik: As part of our study, we tested whether longer-storage blood would cause increased cardiac strain compared with shorter-storage blood. Those data have been analyzed and are now undergoing peer review.
Effect of Transfusion of Red Blood Cells With Longer vs Shorter Storage Duration on Elevated Blood Lactate Levels in Children With Severe Anemia The TOTAL Randomized Clinical Trial JAMA Dec 5 2015
Dr. Walter H. Dzik MD (2015). Stored Blood For Transfusions Works As Well As Fresh Blood