While the U.S. Food
and Drug Administration regulations allow for blood to be stored up to 42
days before it must be discarded, researchers at Cooper University Hospital
(CVH) in Camden, NJ, found that blood stored nearly two weeks less than that
still might be problematic. The average age of blood used in U.S.
transfusions is around 17 days. Reuters reports that patients given
transfusions of blood stored 29 days or longer are twice as likely to get a
hospital-acquired infection as those getting newer blood. One of the CVH
researchers explains that this infection is not derived from hepatitis, HIV,
or other things that, potentially, could be transmitted in the transfused
blood but are attributable to an increased susceptibility to infection as a
result of the transfusion.
According to the researchers, if the patients
they studied (422 hospitalized in intensive-care units and given blood
transfusions during July 2003 to September 2006) got blood stored 29
days or more, they developed blood-stream infections, pneumonia,
urinary-tract infections, heart-valve infections, sepsis, and other
infections at twice the rate of patients getting blood stored for up to
28 days. These infections were not caused by blood that was already
tainted at the time it was donated but because it degraded over time.
Stored red-blood cells experience changes that
promote the release of biochemical substances called cytokines that can
lower a patient's immune function and render them more vulnerable to
infection. The study is not the first to find health problems in people
getting transfusions of relatively older blood. In March, researchers at
Ohio's Cleveland Clinic reported that heart-surgery patients who
received transfusions with blood stored more than 14 days were more
likely to experience complications including shorter survival times.
Dr. David Gerber of CVH does not endorse
shortening the 42-day policy since that could cut the amount available
in the blood supply: “There is a finite supply of donated blood. In the
back of my mind, I always have to wonder what happens if there is a
natural disaster — or an un-natural disaster — and there is a tremendous
strain on the blood supply.”
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Universal access to safe blood transfusion
Mark your calendar for June 14, 2009, as World
Blood Donor Day. The World Health Organization (WHO) notes that although
millions of lives are saved each year through blood transfusions, in
many countries there still remain inadequate supplies of blood and/or
blood products. Severely impacted are women with pregnancy-related
complications; children suffering from malnutrition, malaria, and/or
life-threatening anemia; trauma victims; and the poor and disadvantaged.
In many of these countries where blood is available, recipients remain
at risk of transfusion-transmissible infections resulting from poor
blood-donor recruitment and selection practices as well as the use of
untested units of blood. In recognition of World Blood Donor Day next
year, WHO's Blood Transfusion Safety (BTS) team supports the
establishment of sustainable national blood programs to ensure provision
of safe, high-quality blood and blood products that are accessible to
all patients requiring transfusion, along with their safe and
appropriate use. Primary among the BTS team's recommendations is making
certain that countries have a comprehensive quality system that covers
the entire transfusion process, from donor recruitment to the follow up
of recipients of transfusion.
