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The Red Blood Cell Storage Lesion: A Controversy of Biology Versus Randomized Controlled Trials

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Essentials of Blood Product Management in Anesthesia Practice

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Abstract

Randomized controlled trials (RCTs) are reporting no difference in mortality when older v. fresher blood is transfused, yet the biology of red cell aging (storage lesions) in the blood bank shows multiple effects. The contrast of cellular biologic changes of cells removed from circulation, then stored versus outcome research is important. The difference in conclusions from these research avenues drives practice. Many physicians may be confused in light of a Cleveland Clinic retrospective study that created controversy over outcomes, after older blood was transfused. That paper sparked public hearings held by the U.S. Food and Drug Administration (FDA). Widely disparate results exist regarding the biology of aged stored blood, retrospective outcome data, and RCTs. This review poses the question of whether the RCTs to date have been designed with hypotheses based upon the findings of the biology. The RCTs have not utilized non-inferiority design- what is required for proving a negative. Therefore, it remains unclear, if claims, being made today, that age of stored blood does not make a difference are scientifically valid. In the end, much work is yet to be done. Furthermore, no RCTs have been conducted comparing the use of stored blood (any age) to the use of best practices in patient blood management to avoid transfusion altogether, but that is a different question.

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Authors and Affiliations

  1. University of Florida, Department of Anesthesiology, Gainesville, FL, USA

    Lauren Smajdor

  2. University of Florida Health, Gainesville, FL, USA

    Bruce D. Spiess

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  1. Lauren Smajdor
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Correspondence to Lauren Smajdor .

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Editors and Affiliations

  1. NYU-Grossman School of Medicine, Department of Anesthesiology, New York, NY, USA

    Corey S. Scher

  2. Departments of Anesthesiology and Pharmacology Toxicology, and Neurosciences, Louisiana State University School of Medicine-Shreveport, Shreveport, LA, USA

    Alan David Kaye

  3. Department of Anesthesiology and Perioperative Medicine, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA

    Henry Liu

  4. NYU Grossman School of Medicine, Department of Anesthesiology, Perioperative Care and Pain Medicine, New York, NY, USA

    Seth Perelman

  5. NYU-Grossman School of Medicine, Department of Anesthesiology, New York, NY, USA

    Sarah Leavitt

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Smajdor, L., Spiess, B.D. (2021). The Red Blood Cell Storage Lesion: A Controversy of Biology Versus Randomized Controlled Trials. In: Scher, C.S., Kaye, A.D., Liu, H., Perelman, S., Leavitt, S. (eds) Essentials of Blood Product Management in Anesthesia Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-59295-0_48

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