In a finding that runs counter to commonly held beliefs about fresh blood being better, a randomized clinical trial shows that acutely ill premature babies who received fresher blood did not fare better than those who received the current standard of care. There was no difference between the two approaches with respect to major organ injury, mortality and infection.
Previous observational studies of patient outcomes used already existing clinical data, which is problematic for a number of key reasons. Determining the average age of blood and its impact for those transfused more than once is very difficult because the age of red blood cells used in each transfusion could range dramatically within the acceptable shelf life of 42 days.
Called the ARIPI Randomized Trial, which stands for Age of Red Blood Cells in Premature Infants, this study involved 377 babies weighing less than 1,250 grams and requiring red blood cell transfusions. Randomly, they either received blood that had been stored a week or less, or received the current standard of practice used by blood banks. It turned out that there was no difference in outcome between the two groups. The ARIPI trial included six Canadian hospitals: The Ottawa Hospital, Children's Hospital of Eastern Ontario (Ottawa), Jewish General Hospital (Montreal), Royal University Hospital (Saskatoon), Children's and Women's Health Centre of British Columbia (Vancouver), and CHU Sainte-Justine (Montreal).
"Over the years, the number of retrospective studies showing possible harm from older blood has created pressure to change the management of the blood supply to provide fresher transfusion products," says Dr. Dana Devine, Vice President, Medical, Scientific&Research Affairs of Canadian Blood Services. "This is a huge undertaking that would require many more donations than we currently have and greatly increase the cost of operating the blood system. To have this particular human clinical trial saying otherwise is important because it is the first such study using the highest level of evidence, the randomized controlled trial, and it was done in a very vulnerable patient population."
The findings of this trial, which took place between May 2006 and June 2011, could not have happened without the hundreds of parents who consented to enroll their children in the study, the participating hospitals noted.
"For the families, it's a difficult decision at a difficult time to allow their tiny and fragile child to be a part of a clinical trial. On behalf of the entire team involved in this trial, I salute and thank the families for allowing us to make this important finding," says Dr. Nicole Rouvinez-Bouali, an academic neonatologist at the Children's Hospital of Eastern Ontario.
- Can Blood Transfusions Cause More Cancer?
- When Should Blood Transfusions Be Given After Cardiac Surgery?
- Recycling Patient Blood During Surgery Better Than Using Banked Blood
- Blood Transfusion: Banked Blood May Do More Harm Than Good, Say Researchers
- Clinical Trials For Rich Patients Could Help Find Cures For Us All