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Older Blood As Good As Fresh for Critically Ill Patients

OTTAWA, CANADA – Milk and blood may both be the elixir of life in certain circumstances, but blood has a much longer shelf life.

In fact, despite conventional wisdom, new research published online recently by the New England of Medicine indicates that blood stored for three weeks is just as good as fresh blood. In other words, if any physicians in your ED are sticklers for fresh blood, show them this study.

The Age of Blood Evaluation (ABLE) study, led by researchers from the Ottawa Hospital Research Institute, is a randomized double-blind trial designed to compare mortality after 90 days in intensive care patients transfused with either fresh blood (stored for an average of six days) or older blood (stored for an average of 22 days). The study included participation from 2,430 adults in 64 medical centers in Canada and Europe – 1,211 patients in the fresh blood group and 1,219 in the older blood group.

"Current blood bank practice is to provide patients with the oldest blood available. Some doctors, however, feel that fresh blood is better,” said co-author Paul Hébert, MD, an intensive care physician-scientist at the Centre de recherche du CHUM and professor at the Université de Montréal.

It turns out that isn’t true at all.

"There was no difference in mortality or organ dysfunction between the two groups, which means that fresh blood is not better than older blood,” points out co-author Dean Fergusson, PhD, a senior scientist at the Ottawa Hospital Research Institute and the University of Ottawa.

The study found that 423 patients receiving fresh blood died within 90 days post-transfusion compared to 398 patients in the older blood group.No significant differences were found among any of the secondary outcomes such as major illness; duration of respiratory, hemodynamic or renal support; hospital length of stay, or transfusions reactions.

The authors note that previous observational and laboratory studies have questioned whether fresh blood might be preferable because of the breakdown of red blood cells and accumulation of toxins during storage but said this study did not bear that out.

Under current standards, blood is stored up to 42 days. Some physicians have begun to ask for fresh blood in recent years, which creates difficulty because of limited supply and because blood collection agencies and hospitals tend to distribute blood on a “first-in, first out” basis to avoid waste, the researchers note.

Yet, the authors conclude, “transfusion of fresh red cells, as compared with standard-issue cells, did not decrease the 90-day mortality among critically ill adults.”

The same study team is planning a similar clinical trial in pediatric patients.