Should Old Red Cells be Transfused in Critically III Patients?

  • P. C. Hébert
  • I. Chin-Yee
Part of the Yearbook of Intensive Care and Emergency Medicine book series (YEARBOOK, volume 2000)


Despite a move towards decreasing transfusion thresholds and the development of strategies designed to avoid exposure to all blood products, allogeneic red blood cell (RBC) transfusions remain an important supportive measure for critically ill patients and patients undergoing operative interventions with significant blood loss [1]. In a recent study examining transfusion practice in critically ill patients, we documented that 25% of all patients receive RBC transfusions [2]. Although the proportion of patients transfused may have decreased in the past few years, cardiac surgical procedures and critically ill patients continue to consume a large proportion of the blood supply.


Acid Citrate Dextrose Storage Lesion Citrate Phosphate Dextrose Fresh RBCs Oxygen Supply Dependency 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Hebert PC, Wells G, Martin C, et al (1999) Variation in red cell transfusion practice in the intensive care unit: a multicentre cohort study. Crit Care 3: 57–63PubMedCrossRefGoogle Scholar
  2. 2.
    Hebert PC, Wells G, Tweeddale M, et al (1997) Does transfusion practice affect mortality in critically ill patients? Am J Respir Crit Care Med 155: A20 (Abst)CrossRefGoogle Scholar
  3. 3.
    Hebert PC, Wells G, Blajchman MA, et al (1999) A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 340: 409–417PubMedCrossRefGoogle Scholar
  4. 4.
    American Society of Anesthesiologists Task Force on Blood Component Therapy (1996) Practice guidelines for blood component therapy. Anesthesiology 84: 732–747CrossRefGoogle Scholar
  5. 5.
    Hebert PC, Hu LQ, Biro GP (1997) Review of physiologic mechanisms in response to anemia. Can Med Assoc 156: S27 - S40Google Scholar
  6. 6.
    Barcroft J (1925) The respiratory function of the blood. Part I: lessons from high altitudes. Cambridge University PressGoogle Scholar
  7. 7.
    Tuman KJ (1990) Tissue oxygen delivery. The physiology of anemia. Anesth Clin North Am 8: 451–469Google Scholar
  8. 8.
    Ronco JJ, Fenwick JC, Tweeddale MG, et al (1993) Identification of the critical oxygen delivery for anaerobic metabolism in critically ill septic and nonseptic humans. JAMA 270: 1724–1730PubMedCrossRefGoogle Scholar
  9. 9.
    Shibutani K, Komatsu T, Kubal K, Sanchala V, Kumar V, Bizzarri DV (1983) Critical level of oxygen delivery in anesthetized man. Crit Care Med 11: 640–643PubMedCrossRefGoogle Scholar
  10. 10.
    Nelson DP, Samsel RW, Wood LDH, Schumacker PT (1988) Pathological supply dependence of systemic and intestinal 02 uptake during endotoxemia. J Appl Physiol 64: 2410–2419PubMedGoogle Scholar
  11. 11.
    Nelson DP, King CE, Dodd SL, Schumacker PT, Cain SM (1987) Systemic and intestinal limits of 02 extraction in the dog. J Appl Physiol 63: 387–394PubMedGoogle Scholar
  12. 12.
    Mollison PL, Young JM (1942) In vivo survival in the human subject of transfused erythrocytes after storage in various preservative solutions. Q J Exp Physiol 31: 359Google Scholar
  13. 13.
    Loutit JF, Mollison PL, Young JM (1943) Citric acid-sodium-citrate-glucose mixtures for blood storage. Q J Exp Physiol 32: 183Google Scholar
  14. 14.
    Simon ER (1962) Red cell preservation: further studies with adenine. Blood 20: 485–491PubMedGoogle Scholar
  15. 15.
    Simon ER, Chapman RG, Finch CA (1962) Adenine in red cell preservation. J Clin Invest 41: 351–359PubMedCrossRefGoogle Scholar
  16. 16.
    Orlina AR, Josephson AM (1969) Comparative viability of blood stored in ACD and CPD. Transfusion 9: 62–69PubMedCrossRefGoogle Scholar
  17. 17.
    Dern RJ, Brewer GJ, Wiorkowski JJ (1967) Studies on the preservation of human blood. II. The relationship of erythrocyte adenosine triphosphate levels and other in vitro measures to red cell storageability. J Lab Clin Med 69: 968–978Google Scholar
  18. 18.
    Dern RJ, Wiorkowski JJ, Matsuda T (1970) Studies on the preservation of human blood. V. The effect of mixing anticoagulated blood during stroage on the poststorage erythrocyte survival. J Lab Clin Med 75: 37–42Google Scholar
  19. 19.
    Moore GL, Peck CC, Sohmer PR, Zuck TF (1981) Some properties of blood stored in anticoagulant CPDA-1 solution. A brief summary. Transfusion 21: 135–137Google Scholar
  20. 20.
    Chin-Yee I, Arya N, D’Almeida M (1997) The red cell storage lesion and its implication for transfusion. Transfus Sci 18: 447–458PubMedCrossRefGoogle Scholar
  21. 21.
    Card RT (1988) Red cell membrane changes during storage. Trans Med Rev 2: 40–47CrossRefGoogle Scholar
  22. 22.
    Wolfe LC (1985) The membrane and the lesions of storage in preserved red cells. Transfusion 5: 185–203CrossRefGoogle Scholar
  23. 23.
    Greenwalt TJ, Bryan DJ, Dumaswala UJ (1984) Erythrocyte membrane vesiculation and changes in membrane components during storage in citrate-phosphate-dextrose-adenine-1.Vox Sang 47: 261–270Google Scholar
  24. 24.
    Snyder LM, Fairbanks G, Trainor J, Fortier NL, Jacobs JB, Leb L (1985) Properties and characterization of vesicules released by young and old human red cells. Br J Haematol 59: 513–522PubMedCrossRefGoogle Scholar
  25. 25.
    Wagner GM, Chiu DTY, Yee MC, Lubin BH (1986) Red cell vesiculation–a common membrane physiologic event. J Lab Clin Med 108: 315–324PubMedGoogle Scholar
  26. 26.
    Knight JA, Voorhees RP, Martin L, Anstall H (1992) Lipid peroxidation in stored red cells. Transfusion 32: 354–357PubMedCrossRefGoogle Scholar
  27. 27.
    Card RT, Mohandas N, Perkins HA, Shohet SB (1982) Deformability of stored red blood cells. Relationship to degree of packing. Transfusion 22: 96–101Google Scholar
  28. 28.
    Card RT, Mohandas N, Mollison PL (1983) Relationship of post-transfusion viability to deform-ability of stored red cells. Br J Haematol 53: 237–240PubMedCrossRefGoogle Scholar
  29. 29.
    Card RT, Fergusson DJ (1987) Relationship of stored red cell deformability to survivability following transfusion: In vitro prediction of in vivo viability. Blood 70: 327a (Abst)Google Scholar
  30. 30.
    Valeri CR, Collins FB (1971) Physiologic effects of 2,3-DPG-depleted red cells with high affinity for oxygen. J Appl Physiol 31: 823–827PubMedGoogle Scholar
  31. 31.
    Valeri CR, Hirsh NM (1969) Restoration in vivo of erythrocyte adenosine triphosphate, 2.3-diphosphoglycerate, potassium ion, and sodium ion concentrations following the transfusion of acid-citrate-dextrose-stored human red blood cells. J Lab Clin Med 73: 722–733PubMedGoogle Scholar
  32. 32.
    Valeri CR, Rorth M, Zaroulis CG, Jakubowski MS, Vescera SV (1975) Physiologic effects of transfusing red blood cells with high or low affinity for oxygen to passively hyperventilated, anemic baboons: systemic and cerebral oxygen extraction. Ann Surg 181: 106–113PubMedCrossRefGoogle Scholar
  33. 33.
    Dennis RC, Hechtman HB, Berger RL, Vito L, Weisel RD, Valeri CR (1978) Transfusion of 2,3DPG-enriched red blood cells to improve cardiac function. Ann Thorac Surg 26: 17–26PubMedCrossRefGoogle Scholar
  34. 34.
    Chaplin HJr, Beutler E, Collins JA, Giblett ER, Polesky HF (1974) Current status of red-cell preservation and availability in relation to the development National Blood Policy. N Engl J Med 291: 68–74CrossRefGoogle Scholar
  35. 35.
    Bunn HF, May MH, Kocholaty WF, Shields CE (1969) Hemoglobin function in stored blood. J Clin Invest 48: 311–321PubMedCrossRefGoogle Scholar
  36. 36.
    Sugerman HJ, Davidson DT, Vibul S, Delivoria-Papadopoulos M, Miller LD, Oski FA (1970) The basis of defective oxygen delivery from stored blood. Surg Gynecol Obstet 137: 733–741Google Scholar
  37. 37.
    Valeri CR, Collins FB (1971) The physiologic effect of transfusing preserved red cells with low 2,3-diphosphoglycerate and high affinity for oxygen. Vox Sang 20: 397–403PubMedCrossRefGoogle Scholar
  38. 38.
    Latham JT Jr, Bove JR, Weirich FL (1982) Chemical and hematologic changes in stored CPDA-1 blood. Transfusion 22: 158–159PubMedCrossRefGoogle Scholar
  39. 39.
    Heddle NM (1995) Febrile nonhemolytic transfusion reactions to platelets. Curr Opin Hematol 3: 478–483CrossRefGoogle Scholar
  40. 40.
    Smith KJ, Sierra ER, Nelson EJ (1993) Histamine, IL-1(3, and IL-8 increase in packed RBCs stored for 42 days but not in RBCs leukodepleted pre-storage. Transfusion 33: 535 (Abst)CrossRefGoogle Scholar
  41. 41.
    Miletic VD, Popovic O (1993) Complement activation in stored platelet concentrates. Transfusion 33: 150–154PubMedCrossRefGoogle Scholar
  42. 42.
    Schleuning M, Bock M, Mempel W (1994) Complement activation during storage of single-donor platelet concentrates. Vox Sang 67: 144–148PubMedCrossRefGoogle Scholar
  43. 43.
    Silliman CC, Clay KL, Thurman GW, Johnson CA, Ambruso DR (1994) Partial characterization of lipids that develop during the routine storage of blood and prime the neutrophil NADPH oxidase. J Lab Clin Med 124: 684–694PubMedGoogle Scholar
  44. 44.
    Muylle L, Peetermans ME (1994) Effect of prestorage leukocyte removal on the cytokine levels in stored platelet concentrates. Vox Sang 66: 14–17PubMedCrossRefGoogle Scholar
  45. 45.
    Aye MT, Palmer DS, Giulivi A, Hashemi S (1995) Effect of filtration of paltelt concentrates on the accumulation of cytokines and platelet release factor during storage. Transfusion 35: 117–124PubMedCrossRefGoogle Scholar
  46. 46.
    Stack G, Snyder EL (1994) Cytokine generation in stored platelet concentrates. Transfusion 34: 20–25PubMedCrossRefGoogle Scholar
  47. 47.
    Stack G, Baril L, Napychank P (1995) Cytokine generation in stored, white cell-reduced, and bacterially contaminated units of red cells. Transfusion 35: 199–203PubMedCrossRefGoogle Scholar
  48. 48.
    Silliman C, Thurman G,Ambruso D (1992) Agents that prime the neutrophil (PMN) oxidase develop during routine storage of platelet concentrates. Blood 80: 365a (Abst)Google Scholar
  49. 49.
    Allard J, Silliman C, Ambruso D, Voelkel NF (1996) A model of transfusion related acute lung injury (TRALI). Am J Respir Crit Care Med 153: A191 (Abst)CrossRefGoogle Scholar
  50. 50.
    Chin-Yee I, Keeney M, Krueger L, Dietz G, Moses G (1998) Supernatant from stored red cells activates neutrophils. Transfus Med 8: 49–56PubMedCrossRefGoogle Scholar
  51. 51.
    Fitzgerald R, Potter RF, Dietz G, Kovacs M, Sibbald WJ (1994) The effect of transfusing aged red blood cells in oxygen supply dependency. Chest 106: 55S (Abst)CrossRefGoogle Scholar
  52. 52.
    Sielenkamper A, D’Almeida M, White M, Martin CM, Sibbald WJ, Chin-Yee I (1996) Diaspirin crosslinked hemoglobin (DCLHb) increases oxygen uptake in septic, oxygen supply-dependent rats. American Thoracic Society International Conference (Abst )Google Scholar
  53. 53.
    Chin-Yee I, Martin C, D’Almeida M, Kovacs MJ, Dietz G, Sibbald W (1995) An animal model for evaluation of the efficacy of red cell (RBC) transfusion. Blood 86: 446a (Abst)Google Scholar
  54. 54.
    D’Almeida MS, Gray D, White M, Chin-Yee IH (1998) Development of an animal model to assess the impact of the erythrocyte storage lesion on tissue 02 availability following transfusion. Canadian Society for Transfusion Medicine Bulletin Vol 10 (Abst)Google Scholar
  55. 55.
    Fratantoni JC (1991) Points to consider in the safety evaluation of hemoglobin-based oxygen carriers. Transfusion 31: 369–371CrossRefGoogle Scholar
  56. 56.
    NIH Consensus Panel (1985) Fresh-frozen plasma. Indications and risks. JAMA 253: 551–553CrossRefGoogle Scholar
  57. 57.
    Gattinoni L, Brazzi L, Pelosi P, et al (1995) A trial of goal-oriented hemodynamic therapy in critically ill patients. N Engl J Med 333: 1025–1032PubMedCrossRefGoogle Scholar
  58. 58.
    Boyd 0, Ground M, Bennett D (1993) A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high risk surgical patients. JAMA 270: 2699–2707PubMedCrossRefGoogle Scholar
  59. 59.
    Hayes MA, Timmins AC, Yan EHS, Palazzo M, Hinds CJ, Watson D (1994) Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 330: 1717–1722PubMedCrossRefGoogle Scholar
  60. 60.
    Dietrich KA, Conrad SA, Hebert CA, Levy GL, Romero MD (1990) Cardiovascular and metabolic response to red blood cell transfusion in critically ill volume-resuscitated nonsurgical patients. Crit Care Med 18: 940–944PubMedCrossRefGoogle Scholar
  61. 61.
    Marik PE, Sibbald WJ (1993) Effect of stored-blood transfusion on oxygen delivery in patients with sepsis. JAMA 269: 3024–3029PubMedCrossRefGoogle Scholar
  62. 62.
    Silverman HJ, Tuma P (1992) Gastric tonometry in patients with sepsis. Effects of dobutamine infusions and packed red blood cell transfusions. Chest 102: 184–188Google Scholar
  63. 63.
    Hurd TC, Dasmahapatra KS, Rush BF, Machiedo GW (1988) Red blood cell deformability in human and experimental sepsis. Arch Surg 123: 217–220PubMedCrossRefGoogle Scholar
  64. 64.
    Langenfeld JE, Livingston DH, Machiedo GW (1991) Red cell deformability is an early indicator of infection. Surgery 110: 398–404PubMedGoogle Scholar
  65. 65.
    Baker CH, Wilmoth FR, Sutton ET (1986) Reduced RBC versus plasma microvascular flow due to endotoxin. Circ Shock 20: 127–139PubMedGoogle Scholar
  66. 66.
    Moffitt DL, Poulos ND (1991) The role of pentoxyfilline in endotoxin-induced alterations of red cell deformability and whole blood viscosity in the neonate. J Pediatr Surg 26: 572–574CrossRefGoogle Scholar
  67. 67.
    Powell RJ, Machiedo GW, Rush BF Jr, Dikdan G (1991) Oxygen free radicals: effect on red blood cell deformability in sepsis. Crit Care Med 19: 732–735PubMedCrossRefGoogle Scholar
  68. 68.
    Hersch M, Gnidec AA, Bersten AD, Troster M, Rutledge FS, Sibbald WJ (1990) Histologic and ultrastructural changes in nonpulmonary organs during early hyperdynamic sepsis. Surgery 107: 397–410PubMedGoogle Scholar
  69. 69.
    Hersch M, Bersten AD, Rutledge FS, Troster M, Groom A, Sibbald WJ (1989) Quantitative evidence of microcirculatory compromise in skeletal muscle of normotensive hyperdynamic septic sheep. Crit Care Med 17: S60 (Abst)Google Scholar
  70. 70.
    Martin CM, Sibbald WJ, Lu X, Hebert P, Schweitzer I (1994) Age of transfused red blood cells is associated with ICU length of stay. Clin Invest Med 17: 124 (Abst)Google Scholar
  71. 71.
    Purdy FR, Tweeddale MG, Merrick PM (1997) Association of mortality with age of blood transfused in septic ICU patients. Can J Anaesth 44: 1256–1261PubMedCrossRefGoogle Scholar
  72. 72.
    Vamvakas EC, Carven JH (1999) Transfusion and postoperative pneumonia in coronary artery bypass graft surgery: effect of the length of storage of transfused red cells. Transfusion 39: 701–710PubMedCrossRefGoogle Scholar
  73. 73.
    Gutierrez G, Pohil RJ (1986) Oxygen consumption is linearly related to 02 supply in critically ill patients. J Crit Care 1: 45–53CrossRefGoogle Scholar
  74. 74.
    Bihari D, Smithies M, Gimson A, Tinker J (1987) The effects of vasodilation with prostacyclin on oxygen delivery and uptake in critically ill patients. N Engl J Med 317: 397–403PubMedCrossRefGoogle Scholar
  75. 75.
    Hebert PC, Drummond AJ, Singer J, Bernard GR, Russell JE (1993) A simple multiple system organ failure scoring system predicts mortality of patients who have sepsis syndrome. Chest 104: 230–235PubMedCrossRefGoogle Scholar
  76. 76.
    Marshall JC (1994) A scoring system for multiple organ dysfunction syndrome. In: Reinhart K, Eyrich K, Sprung C (eds) Sepsis. Current perspectives in pathophysiology and therapy. Springer-Verlag, Berlin, pp 38–49Google Scholar
  77. 77.
    Knaus W, Draper EA, Wagner DP, Zimmerman JE (1985) Prognosis in acute organ-system failure. Ann Surg 202: 685–693PubMedCrossRefGoogle Scholar
  78. 78.
    Marshall JC, Christou NV, Meakins JL (1993) The gastrointestinal tract. The `undrained abscess’ of multiple organ failure. Ann Surg 218: 111–119Google Scholar
  79. 79.
    Carrico CJ, Meakins JL, Marshall JC, Fry DE, Maier RV (1986) Multiple-organ-failure syndrome. Arch Surg 121: 196–208PubMedCrossRefGoogle Scholar
  80. 80.
    Fiddian-Green RG (1989) Studies in splanchnic ischemia and multiple organ failure. In: Marston A, Bulkley GB, Fiddian-Green RG, Haglund U (eds) Splanchnic ischemia and multiple organ failure. Mosby Co, London, pp 349–363Google Scholar
  81. 81.
    Sibbald WJ, Bersten A, Rutledge FS (1989) The role of tissue hypoxia in MOF. In: Reinhart K, Eyrich K (eds) Clinical aspects of oxygen transport and tissue oxygenation. Springer-Verlag, Berlin, pp 102–114Google Scholar
  82. 82.
    Martin CM, Iwao Y, Potter R, Chin-Yee IH, Sibbald WJ (1996) Decreased mucosal capillary perfusion following transfusion of stored blood in control and septic rats. Am J Respir Crit Care Med 153: A464 (Abst)CrossRefGoogle Scholar
  83. 83.
    Ronco JJ, Montaner JSG, Fenwick JC, Ruedy J, Russell JA (1990) Pathologic dependence of oxygen consumption on oxygen delivery in acute respiratory failure secondary to AIDS-related Pneumocystis carinii pneumonia. Chest 98: 1463–1466PubMedCrossRefGoogle Scholar
  84. 84.
    Fenwick JC, Dodek PM, Ronco JJ, Phang PT,Wiggs B, Russell JA (1990) Increased concentrations of plasma lactate predict pathologic dependence of oxygen consumption on oxygen delivery in patients with adult respiratory distress syndrome. J Crit Care 5: 81–86Google Scholar
  85. 85.
    Ronco JJ, Phang PT, Walley KR, Wiggs B, Fenwick JC, Russell JA (1991) Oxygen consumption is independent of changes in oxygen delivery in severe adult respiratory distress syndrome. Am Rev Respir Dis 143: 1267–1273PubMedCrossRefGoogle Scholar
  86. 86.
    Shah DM, Gottlieb ME, Rahm RL, et al (1982) Failure of red blood cell transfusion to increase oxygen transport or mixed venous P02 in injured patients. J Trauma 22: 741–746PubMedCrossRefGoogle Scholar
  87. 87.
    Steffes CP, Bender JS, Levison MA (1991) Blood transfusion and oxygen consumption in surgical sepsis. Crit Care Med 19: 512–517PubMedCrossRefGoogle Scholar
  88. 88.
    Babineau TJ, Dzik WH, Borlase BC, Baxter JK, Bistrian BR, Benotti PN (1992) Reevaluation of current transfusion practices in patients in surgical intensive care units. Am J Surg 164: 22–25PubMedCrossRefGoogle Scholar
  89. 89.
    Gilbert EM, Haupt MT, Mandanas RY, Huaringa AJ, Carlson RW (1986) The effect of fluid loading, blood transfusion, and catecholamine infusion on oxygen delivery and consumption in patients with sepsis. Am Rev Respir Dis 134: 873–878PubMedGoogle Scholar
  90. 90.
    Conrad SA, Dietrich KA, Hebert CA, Romero MD (1990) Effect of red cell transfusion on oxygen consumption following fluid resuscitation in septic shock. Circ Shock 31: 419–429PubMedGoogle Scholar
  91. 91.
    Lorente JA, Landin L, De Pablo R, Renes E, Rodriguez-Diaz R, Liste D (1993) Effects of blood transfusion on oxygen transport variables in severe sepsis. Crit Care Med 21: 1312–1318PubMedCrossRefGoogle Scholar
  92. 92.
    Mink RB, Pollack MM (1990) Effect of blood transfusion on oxygen consumption in pediatric septic shock. Crit Care Med 18: 1087–1091PubMedCrossRefGoogle Scholar
  93. 93.
    Lucking SE, Williams TM, Chaten FC, Metz RI, Mickell JJ (1990) Dependence of oxygen consumption on oxygen delivery in children with hyperdynamic septic shock and low oxygen extraction. Crit Care Med 18: 1316–1319PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2000

Authors and Affiliations

  • P. C. Hébert
  • I. Chin-Yee

There are no affiliations available

Personalised recommendations