A recent study funded by the National Institutes of Health found no statistical contrast in function changes of six organs before and after cardiac surgery in patients with complex complications who received blood transfusions stored for 10 days compared to longer periods of 21 days or more. These outcomes were published in the New England Journal of Medicine journal and show it is not necessary to change how hospitals currently manage the blood transfusion issue.
In the United States, units of red blood cells can be kept up to 42 days after being collected. This new research project measured alterations in units throughout different periods of storage, as previous studies have evidenced a relationship between increased mortality and morbidity and the transfusion of blood that was stored for longer periods.
The RECESS multicenter trial was conducted by both the NHLBI-funded Transfusion Medicine and Hemostasis Clinical Trial Network (TMH CTN) in over two dozen hospitals across the United States between January 2010 and January 2014. One data coordinating center and 17 clinical centers are included in the TMH CTN.
RECESS assessed 1,098 patients who had cardiac surgery and were randomly selected to receive red blood cell units stored for longer or shorter periods of time. Researchers found no statistical contrast in the change of Multiple Organ Dysfunction Score (MODS), primary clinical assessment or mortality from before cardiac surgery to 7 or 28 days after the operation for both transfusion groups; the MODS evaluation assessed the respiratory, hepatic, renal, cardiovascular, neurologic and hematologic systems. Investigators noticed there were also no statistical differences in the mean number of both non-serious and serious adverse events between the two groups. As RECESS evaluated few patients under the age of 18 years, these findings apply mainly to adult patients.
“RECESS contributes to a long-standing question about whether red blood cell storage duration impacts a patient’s clinical outcome after transfusion. These findings are reassuring because they do not support the need to modify transfusion practices in adult patients undergoing complex cardiac surgery. In particular, there does not appear to be something gained by only transfusing red blood products stored for ten days or less,” stated Dr. Keith Hoots, the director of the NHLBI Division of Blood Diseases and Resources.
