A. Lubitz1, K. Hollenbach2, E. Chan1, E. Dauer1, L. Sjoholm1, A. Pathak1, T. Santora1, A. Goldberg1, J. Rappold1 1Temple University School Of Medicine,Department Of Surgery,Philadelpha, PA, USA 2University Of California – San Diego,Skaggs School Of Pharmacy And Pharmeceutical Sciences,San Diego, CA, USA
Introduction: The age of stored packed red blood cells (pRBC) and it's relationship to the development of complications in trauma patients requiring massive transfusions (≥ 10 units pRBC/24 hour) remain poorly understood. Laboratory studies have revealed evidence of the accumulation of storage lesions and decreased oxygen carrying capacity in pRBCs stored for greater than 14 days. The clinical significance of these findings on the development of both infectious and non-infectious complications remains unknown.
Methods: A retrospective cohort study of all massive transfusion (MTP) patients at an urban level 1 trauma center between 2008 and 2012 was conducted. Data were abstracted from the trauma registry and corroborated with medical and blood bank records; included were standard demographic information, mechanism of injury, injury severity score (ISS), the amount and age of pRBCs transfused and patient outcomes. Data were analyzed using STATA 13.1. Variables were created to examine the age of blood received in the MTP resuscitation by week and by < 14 days. Initial comparisons were made using t-tests and chi-square statistics, as appropriate. Logistic regression was used to determine the odds of complication associated with percent of blood < 14 days of age. Subsequent analyses were conducted independently for both infectious and non-infectious complications.
Results: There were a total of 133 MTP patients during the study period: 70 with at least one complication and 63 with no complications. The mean age of patients with complications was slightly younger than those without complications (30.3±10.8 vs. 32.1±14.1). Patients with complications had lower injury severity scores (ISS) than patients without complications (24.1±13.4 vs. 27.9±19.1). Patients with complications were 3.3 times more likely to have 50% or more blood transfused that was ≥ 14 days of age than patients with no complications (95% CI = 1.4, 8.3). When the analysis was restricted to infectious complications, the effect of aged blood was greater (OR = 5.7; 95% CI = 1.7, 24.4). Neither age nor ISS changed these associations.
Conclusions: These data indicate that aged blood was associated with a significant increased risk of complications. Further studies are warranted to determine what factors in blood ≥ 14 days of age may exist that puts massively transfused trauma patients at risk for the development of complications, particularly infections.
