Red blood cell storage duration and trauma

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Numerous retrospective clinical studies suggest that transfusion of longer-stored red blood cells (RBCs) is associated with an independent risk for poorer outcomes for certain groups of patients, including trauma, intensive care and cardiac surgery patients. Large multi-center randomized controlled trials (RCTs) are currently underway to address the concern about RBC storage duration. However, none of these RCTs focus specifically on trauma patients with hemorrhage. Major trauma, particularly due to road accidents, is the leading cause of critical injury in the under 40 year-old age group. Severe bleeding associated with major trauma induces hemodynamic dysregulation that increases the risk of hypoxia, coagulopathy and potentially multi-organ failure, which can be fatal. In major trauma, a multitude of stress-associated changes occur to the patient’s RBCs, including morphological changes that increase cell rigidity and thereby alter blood flow hemodynamics, particularly in the microvascular vessels, and reduce RBC survival. Initial inflammatory responses induce deleterious cellular interactions, including endothelial activation, RBC adhesion and erythrophagocytosis that are quickly followed by profound immunosuppressive responses. Stored RBCs exhibit similar biophysical characteristics to those of trauma-stressed RBCs. Whether or not transfusion of RBCs that exhibit storage lesion changes exacerbates the hemodynamic perturbations already active in the trauma patient is not known. This paper reviews findings from several recent non-randomized studies examining RBC storage duration and clinical outcomes in trauma patients. The rationale for further research on RBC storage duration in the trauma setting is provided.
Original languageEnglish
Pages (from-to)120-126
Number of pages7
JournalTransfusion Medicine Reviews
Issue number2
Publication statusPublished - 2015


  • Hemorrhage
  • Hemodynamics
  • Immunomodulation
  • microvascular
  • Randomized controlled trial
  • Red blood cell
  • Storage lesion
  • Transfusion
  • Trauma

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