If you need a blood transfusion, the last thing you need to worry about is the age of the donated blood. Researchers from the Cleveland Clinic in Ohio say that adopting modern inventory management strategies could greatly reduce blood storage time and potentially reduce the risk of complications for the patient.

There is a dearth of clinical evidence regarding the length of time donated red blood cells are stored and the outcomes for patients, but it is known that the makeup of the stored blood changes.

In a study published in The Annals of Thoracic Surgery, Dr. Colleen G. Koch and colleagues say:

“Stored blood undergoes changes, meaning that transfusion of older red blood cells may result in the delivery of high concentrations of red blood cell components such as hemoglobin, free iron and red blood cell fragments. These components may contribute to adverse clinical events observed in a number of investigations.”

Even after examining literature about storage-related complications for patients receiving blood transfusions, there was no clear-cut answer as to whether time affected patient outcome.

Several studies in trauma and cardiac surgery linked longer storage time with multiple organ failure, deep vein thrombosis and mortality, while others reported there was no connection between them at all, says Dr. Koch in the study.

She continues:

“Until results of ongoing randomized controlled trials in the area of storage duration are completed, we cannot recommend a change in the current FDA formal guidelines. However, we encourage surgeons to remain aware of the possible complications associated with red blood cell transfusion.”

But the study suggests that simple changes to the storage systems may be of benefit to patients. She adds:

“We recommend further work with inventory management to explore strategies that would optimize fresher blood for patients.”

How long the blood is stored depends on a number of criteria including supply and demand and availability – less common blood groups are usually kept for longer. The study points out that currently, the Food and Drug Administration sets the shelf-life of red blood cells at 42 days.

According to the 2011 National Blood Collection and Utilization Report, 15.7 million units of whole blood and red blood cells were collected in 2011. These are then separated into component parts – plasma, platelets, red blood cells etc – and may be used to treat different patients’ needs.

In 2011, the report shows that almost 21 million blood components were transfused – a figure which is expected to rise as medical advances increase our ability to combat disease. Every day in the US approximately 41,000 units are used by hospitals and emergency facilities to treat patients.

Not all the components of blood have the same storage times. For example, plasma can be frozen and stored for up to a year, but blood platelets have to be kept at room temperature, so must be used within 5 days.

Platelet management requires hourly checks and more frequent deliveries from blood collection agencies to ensure it is used within this timeframe. The researchers say that by using a similar system for red blood cells, storage time could be reduced to 14 days or less.

In the study, Dr. Koch and colleagues recommend revising the existing system of first-in, first-out for red blood cells, designed to minimze the number of wasted units. They suggest exploring inventory management systems favored by the retail sector could reduce storage time.

The researchers add:

“We hope our results engage others in the medical community to investigate alternative inventory management strategies that would contribute to reducing the storage age of the red cell product without adversely influencing inventory availability.”

Witten by Belinda Weber