Effects of red blood cell storage in heavily transfused patients

Purpose of review Most publications on Red Blood Cell (RBC) storage time are performed in patient groups receiving on average 1-4 RBC transfusions. Here we look at the observational results in the more heavily transfused patient populations studied, which are mostly in trauma or cardiac surgery patients. Recent findings New heavily transfused patient groups in which the possible detrimental effects of prolonged RBC storage were studied are HSCT and liver transplant patients. In these studies no associations of prolonged RBC storage with outcome were seen. Apart from these studies, new studies were also reported on ICU patients and cardiac surgery patients. These latter studies reported associations with infections, postoperative length of stay, and renal complications. In these studies similar shortcomings in study design and analysis were encountered as in earlier studies, leading to overestimation of the studied association. Some of the recent studies suggest, contrary to the most encountered opinion, that fresh RBC might be detrimental on some outcomes. Similar observations have recently been presented in other, less heavily transfused populations. Summary Clinical effects of RBC storage turn out to be determined by far more aspects than storage time alone.