Researchers affiliated with Cooper University Hospital in Camden NJ have reported that transfused blood stored longer than 29 days was associated with an increased risk of infection compared to blood stored for a shorter period of time. The details of this study were presented at the annual meeting of the American College of Chest Physicians, which was held October 25-28 in Philadelphia.

Currently, the U.S. Food and Drug Administration allows blood storage of 42 days prior to transfusion. Recently, concern has been raised that long blood storage may increase complications in recipients. Researchers from the Cleveland Clinic Foundation have reported that patients undergoing cardiac surgery have more post-operative complications if transfused with blood stored more than 2 weeks. The increased causes of death included an almost 2-fold increase in sepsis or septicemia.

The current study evaluated 421 transfused patients over a 3-year period. There were 76 nosocomial infections and 53 occurred in patients receiving blood older than 4 weeks. These included urinary tract infections, vascular line infections, bacteremia and culture-negative sepsis. There was no relationship between age of blood and deaths or lengths of hospital stay. These authors concluded that patients who received blood stored for 4 weeks or more had a 3-fold increased incidence of infection compared to patients who received blood stored for less than 4 weeks. The reasons for these effects are unclear, but increasing levels of cytokines with age is one hypothesis.

Comments: The importance of these observations is that a similar study should be carried out in cancer patients, who are more susceptible to infection due to immunodeficiency and granulocytopenia. If these data can be confirmed in cancer patients, it would add to the rationale for relying more on epoetins such as Aranesp® (pegfilgrastim) rather than blood transfusions for maintenance of adequate hemoglobin levels.

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Reference:
Nahra R, et al. Impact of age of blood on nosocomial infections in critically-ill patients. Chest 2008;134:48003S.
Koch CG, Li L, Sessler DI, et al. Duration of red-cell storage complications after cardiac surgery. New England Journal of Medicine 2008;358:1229-1239.