Impact of the age of transfused red blood cells in the trauma population: A feasibility study

Stephen M. Cohn, Mark Derosa, Ashwini Kumar, Chantal Harrison, Daniel L Dent, Sunthosh Sivam, Janet McCarthy, Sherrie Warner, Susan Williams, Joel E Michalek, Philip Spinella

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Following injury, transfusion of red blood cells (RBCs) of increased storage duration has been associated with an increased morbidity and mortality. Prospective trials focusing on the impact of the storage age of RBCs in severely bleeding trauma patients have failed to accrue patients. This has been attributed to an inability to maintain a large inventory of fresh RBCs, and the difficulties in obtaining consent in severely bleeding trauma patients. To address these issues, we performed a prospective, observational pilot study to evaluate the feasibility of conducting a trial focusing on RBC age in patients following injury. Methods Patients with bleeding due to trauma were transfused RBCs ≤10 day old if they were ABO blood Type O (Group O) or were transfused the oldest RBCs in inventory if they were Type A, B or AB (Group A/B/AB). Clinicians were unaware of the specific age of the RBCs. Results 63 patients were analyzed (Group O, n = 19; Group A/B/AB, n = 44). Half of all patients had severe injuries ISS (median 22). The median admission base deficit was -5 mEq/L, and median total 24 h use of RBC and FFP was 1.2 L. The age of RBCs transfused to Group O was significantly lower than for Group A/B/AB [median (IQR) A/B/AB = 18.4 (11.4-25.4) days, and Group O = 6 (4.2-7.8) days; p < 0.001]. Conclusions It appears feasible to conduct a RBC age trial in trauma patients using ABO blood type to construct comparative groups. Adequate RBC age separation between cohorts and reduced RBC age in the "young" group of patients who received units ≤10 days old was achieved.

Original languageEnglish (US)
Pages (from-to)605-611
Number of pages7
JournalInjury
Volume45
Issue number3
DOIs
StatePublished - Mar 2014

Fingerprint

Feasibility Studies
Erythrocytes
Wounds and Injuries
Population
Hemorrhage
Erythrocyte Transfusion
Equipment and Supplies
Cell Separation
Observational Studies
Morbidity

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine
  • Medicine(all)

Cite this

Cohn, S. M., Derosa, M., Kumar, A., Harrison, C., Dent, D. L., Sivam, S., ... Spinella, P. (2014). Impact of the age of transfused red blood cells in the trauma population: A feasibility study. Injury, 45(3), 605-611. https://doi.org/10.1016/j.injury.2013.07.016

Impact of the age of transfused red blood cells in the trauma population : A feasibility study. / Cohn, Stephen M.; Derosa, Mark; Kumar, Ashwini; Harrison, Chantal; Dent, Daniel L; Sivam, Sunthosh; McCarthy, Janet; Warner, Sherrie; Williams, Susan; Michalek, Joel E; Spinella, Philip.

In: Injury, Vol. 45, No. 3, 03.2014, p. 605-611.

Research output: Contribution to journalArticle

Cohn, SM, Derosa, M, Kumar, A, Harrison, C, Dent, DL, Sivam, S, McCarthy, J, Warner, S, Williams, S, Michalek, JE & Spinella, P 2014, 'Impact of the age of transfused red blood cells in the trauma population: A feasibility study', Injury, vol. 45, no. 3, pp. 605-611. https://doi.org/10.1016/j.injury.2013.07.016
Cohn, Stephen M. ; Derosa, Mark ; Kumar, Ashwini ; Harrison, Chantal ; Dent, Daniel L ; Sivam, Sunthosh ; McCarthy, Janet ; Warner, Sherrie ; Williams, Susan ; Michalek, Joel E ; Spinella, Philip. / Impact of the age of transfused red blood cells in the trauma population : A feasibility study. In: Injury. 2014 ; Vol. 45, No. 3. pp. 605-611.
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abstract = "Following injury, transfusion of red blood cells (RBCs) of increased storage duration has been associated with an increased morbidity and mortality. Prospective trials focusing on the impact of the storage age of RBCs in severely bleeding trauma patients have failed to accrue patients. This has been attributed to an inability to maintain a large inventory of fresh RBCs, and the difficulties in obtaining consent in severely bleeding trauma patients. To address these issues, we performed a prospective, observational pilot study to evaluate the feasibility of conducting a trial focusing on RBC age in patients following injury. Methods Patients with bleeding due to trauma were transfused RBCs ≤10 day old if they were ABO blood Type O (Group O) or were transfused the oldest RBCs in inventory if they were Type A, B or AB (Group A/B/AB). Clinicians were unaware of the specific age of the RBCs. Results 63 patients were analyzed (Group O, n = 19; Group A/B/AB, n = 44). Half of all patients had severe injuries ISS (median 22). The median admission base deficit was -5 mEq/L, and median total 24 h use of RBC and FFP was 1.2 L. The age of RBCs transfused to Group O was significantly lower than for Group A/B/AB [median (IQR) A/B/AB = 18.4 (11.4-25.4) days, and Group O = 6 (4.2-7.8) days; p < 0.001]. Conclusions It appears feasible to conduct a RBC age trial in trauma patients using ABO blood type to construct comparative groups. Adequate RBC age separation between cohorts and reduced RBC age in the {"}young{"} group of patients who received units ≤10 days old was achieved.",
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T2 - A feasibility study

AU - Cohn, Stephen M.

AU - Derosa, Mark

AU - Kumar, Ashwini

AU - Harrison, Chantal

AU - Dent, Daniel L

AU - Sivam, Sunthosh

AU - McCarthy, Janet

AU - Warner, Sherrie

AU - Williams, Susan

AU - Michalek, Joel E

AU - Spinella, Philip

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N2 - Following injury, transfusion of red blood cells (RBCs) of increased storage duration has been associated with an increased morbidity and mortality. Prospective trials focusing on the impact of the storage age of RBCs in severely bleeding trauma patients have failed to accrue patients. This has been attributed to an inability to maintain a large inventory of fresh RBCs, and the difficulties in obtaining consent in severely bleeding trauma patients. To address these issues, we performed a prospective, observational pilot study to evaluate the feasibility of conducting a trial focusing on RBC age in patients following injury. Methods Patients with bleeding due to trauma were transfused RBCs ≤10 day old if they were ABO blood Type O (Group O) or were transfused the oldest RBCs in inventory if they were Type A, B or AB (Group A/B/AB). Clinicians were unaware of the specific age of the RBCs. Results 63 patients were analyzed (Group O, n = 19; Group A/B/AB, n = 44). Half of all patients had severe injuries ISS (median 22). The median admission base deficit was -5 mEq/L, and median total 24 h use of RBC and FFP was 1.2 L. The age of RBCs transfused to Group O was significantly lower than for Group A/B/AB [median (IQR) A/B/AB = 18.4 (11.4-25.4) days, and Group O = 6 (4.2-7.8) days; p < 0.001]. Conclusions It appears feasible to conduct a RBC age trial in trauma patients using ABO blood type to construct comparative groups. Adequate RBC age separation between cohorts and reduced RBC age in the "young" group of patients who received units ≤10 days old was achieved.

AB - Following injury, transfusion of red blood cells (RBCs) of increased storage duration has been associated with an increased morbidity and mortality. Prospective trials focusing on the impact of the storage age of RBCs in severely bleeding trauma patients have failed to accrue patients. This has been attributed to an inability to maintain a large inventory of fresh RBCs, and the difficulties in obtaining consent in severely bleeding trauma patients. To address these issues, we performed a prospective, observational pilot study to evaluate the feasibility of conducting a trial focusing on RBC age in patients following injury. Methods Patients with bleeding due to trauma were transfused RBCs ≤10 day old if they were ABO blood Type O (Group O) or were transfused the oldest RBCs in inventory if they were Type A, B or AB (Group A/B/AB). Clinicians were unaware of the specific age of the RBCs. Results 63 patients were analyzed (Group O, n = 19; Group A/B/AB, n = 44). Half of all patients had severe injuries ISS (median 22). The median admission base deficit was -5 mEq/L, and median total 24 h use of RBC and FFP was 1.2 L. The age of RBCs transfused to Group O was significantly lower than for Group A/B/AB [median (IQR) A/B/AB = 18.4 (11.4-25.4) days, and Group O = 6 (4.2-7.8) days; p < 0.001]. Conclusions It appears feasible to conduct a RBC age trial in trauma patients using ABO blood type to construct comparative groups. Adequate RBC age separation between cohorts and reduced RBC age in the "young" group of patients who received units ≤10 days old was achieved.

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