Red Blood Cell Storage Duration is Associated with Various Clinical Outcomes in Pediatric Cardiac Surgery

BACKGROUND:

Recommendations on the use of fresh red blood cells (RBCs) in pediatric patients undergoing cardiac surgery are based on limited information. Furthermore, the RBC storage time cut-off of fresh units remains unknown.

METHODS:

Data from 139 pediatric patients who underwent cardiac surgery
and received RBCs from a single unit within 14 days of storage were
analyzed. To identify the optimal cut-off storage time of RBCs for
transfusion, multiple multivariate analyses aimed at different outcome
parameters were performed.

RESULTS:

26 patients received
RBC units stored for ≤3 days, while 126 patients received RBCs that were
stored for 4-14 days. The latter group required more RBC transfusions
and fresh frozen plasma (FFP) than the former group (19 vs. 25 ml/kg, p =
0.003 and 73% vs. 35%, p = 0.0006, respectively). In addition, the odds
for the administration of FFP increased with the transfusion of RBCs
stored for more than 4 days. The optimal cut-off for post-operative
morbidity was observed with a storage time of ≤6 days for length of
ventilation (p = 0.02) and peak of C-reactive protein (CRP; p = 0.008).

CONCLUSIONS:

The
obtained results indicate that the hazard of blood transfusion
increased with increasing storage time of RBCs. The results of this
study suggest that transfusion of fresh RBCs with a storage time of ≤2
or 4 days (concerning transfusion requirements) or ≤6 days (concerning
postoperative morbidity) may be beneficial in pediatric patients
undergoing cardiac surgery. However, further prospective randomized studies are required in order to draw any final conclusions.