The problem

Patients who are critically ill may need a transfusion of donated red blood cells (RBCs), but these are in short supply and have a shelf life of just a few weeks. To protect the supply, blood transfusion services have traditionally tried to use the older stored products first, but there has been a recent trend to use fresher stored RBCs in case they are better, which puts further pressure on blood supplies. But are older blood stocks just as good?

The project

To determine the best practice, the TRANSFUSE (Standard Issue Transfusion versus Fresher RedCell Use in Intensive Care) trial recruited 4,919 critically ill patients in Ireland, Finland, Saudi Arabia, Australia and New Zealand. Around half of them received the standard, aged RBC products and the other half got the freshest available products.

The outcomes
  • As the largest study of its kind, the TRANFUSE trial determined that standard, older red blood cell products are slightly better for critically ill patients in intensive care, compared to the freshest available products
  • We now know the age of transfused red blood cells does not impact patient survival rates among critically ill adults, and older cells are associated with fewer fevers
  • A smaller trial in Canada found a similar result
  • The findings are changing practices among blood transfusion services and the clinicians that use blood products in critical care
  • The TRANSFUSE trial will boost the available stock of donated red blood cells globally for patients, ensuring that older products are used before fresher ones and reducing the pressure on transfusion services.

Professor Alistair Nichol, Chair of Critical Medicine in UCD, Director of the HRB Irish Critical Care Clinical Trials Network and Consultant Intensivist/ Anaesthetist, St. Vincent’s University Hospital, says:

“Given the large amounts of red blood cell donations transfused globally, making even a small difference to the supply can have a huge impact. In the absence of evidence, some blood transfusion services were reducing the shelf life of RBC products, but with this large study we saw a very clear signal that in the Intensive Care Unit the freshest available blood is not better, and that for critically ill patients the current standard of care is desirable.

“This has closed the chapter on that question, and will have the knock-on effect of reducing the pressure on blood donation and transfusion services around the world. These findings are saving money and lives.”

‘Like a good red wine, stored red blood cells improve with age’ is part of a wider collection of success stories across four themes from this year’s annual Health Research in Action. Download the full publication.