Cartotto Robert, Yeo Caitlin, Camacho Fernando, Callum Jeannie
From the Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
J Burn Care Res. 2014 Mar-Apr;35(2):186-97. doi: 10.1097/BCR.0b013e318295755d.
Blood banks now store blood up to 42 days. With increasing duration of storage, units of red blood cells (RBCs) develop a storage lesion characterized by alterations in oxygen transport capability and heightened proinflammatory properties. However, there is considerable controversy as to whether the storage lesion affects outcomes in transfused patients and burn patients, which has not been studied. The purpose was to identify whether any relationship exists between the storage age of transfused blood and outcome in severely burned adults. This is a retrospective review of adults, with burns 20% or more TBSA, treated at an adult regional ABA-verified burn center, who received at least one RBC transfusion. Subjects were stratified a priori based on the mean age of all RBC units transfused during the first 30 days postburn, to either a Fresh Group (mean storage age ≤28 days), or an Old Group (mean storage age >28 days). The Fresh Group (N = 89) did not differ significantly from the Old Group (N = 38) in baseline characteristics. The median (range) mean blood storage age was 22.2 (10.3-28) days in the Fresh Group and 31.5 (28.3-41) days in the Old Group, (P < .001). The Fresh Group had a significantly higher median daily transfusion rate when alive and in hospital, during the first 30 days postburn, than the Old Group (0.5 [range 0.03-5.5] units/day vs 0.35 [0.03-2.7] units/day; P = .04). There were no significant differences between the groups in mean daily sequential organ failure assessment (SOFA) score, peak SOFA score, delta SOFA score (peak-admission SOFA), time to wound healing, length of stay, and 30-day mortality or in-hospital mortality. Linear regression revealed no significant effect of the mean age of transfused blood on mean daily SOFA score/first 30 days postburn. The Fresh Group had a significantly longer median duration of mechanical ventilation (29 [range 1-195] vs 17 [range 1-80] days, P = .03) and had significantly more sepsis episodes. Transfusion of RBCs with a mean storage age of more than 28 days was not associated with any worsened outcome compared with transfusion of blood with a mean storage age of less than 28 days, among this cohort of adult burn patients. These findings do not suggest the need to preferentially transfuse fresher blood to burn patients, but randomized prospective studies of this question are needed.
血库现在可将血液储存长达42天。随着储存时间的延长，红细胞（RBC）单位会出现一种储存损伤，其特征是氧运输能力改变和促炎特性增强。然而，关于这种储存损伤是否会影响输血患者和烧伤患者的预后存在相当大的争议，对此尚未进行研究。目的是确定输血的储存年龄与成年重度烧伤患者的预后之间是否存在任何关系。这是一项对在一家经美国烧伤协会（ABA）认证的成人区域烧伤中心接受治疗、烧伤面积达20%或更多体表面积（TBSA）且接受至少一次红细胞输血的成年人的回顾性研究。根据烧伤后前30天内输注的所有红细胞单位的平均年龄，将受试者预先分层为新鲜组（平均储存年龄≤28天）或陈旧组（平均储存年龄>28天）。新鲜组（N = 89）与陈旧组（N = 38）在基线特征上无显著差异。新鲜组的中位（范围）平均血液储存年龄为22.2（10.3 - 28）天，陈旧组为31.5（28.3 - 41）天，（P <.001）。新鲜组在烧伤后前30天存活且住院期间的中位每日输血率显著高于陈旧组（0.5 [范围0.03 - 5.5]单位/天 vs 0.35 [0.03 - 2.7]单位/天；P =.04）。两组在平均每日序贯器官衰竭评估（SOFA）评分、最高SOFA评分、SOFA评分差值（最高值 - 入院时SOFA）、伤口愈合时间、住院时间、30天死亡率或院内死亡率方面无显著差异。线性回归显示，输血的平均年龄对烧伤后前30天的平均每日SOFA评分无显著影响。新鲜组的机械通气中位持续时间显著更长（29 [范围1 - 195]天 vs 17 [范围1 - 80]天，P =.03），且脓毒症发作显著更多。在这组成年烧伤患者中，与输注平均储存年龄小于28天的血液相比，输注平均储存年龄超过28天的红细胞与任何更差的预后均无关联。这些发现并不表明需要优先为烧伤患者输注更新鲜的血液，但需要对此问题进行随机前瞻性研究。
