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Cryopreserved red blood cells are superior to standard liquid red blood cells

Hampton, David A. MD; Wiles, Connor; Fabricant, Loïc J. MD; Kiraly, Laszlo MD; Differding, Jerome MPH; Underwood, Samantha MS; Le, Dinh MD; Watters, Jennifer MD; Schreiber, Martin A. MD

Journal of Trauma and Acute Care Surgery: July 2014 - Volume 77 - Issue 1 - p 20–27
doi: 10.1097/TA.0000000000000268
EAST 2014 Plenary Papers
Editor's Choice

BACKGROUND Liquid preserved packed red blood cell (LPRBC) transfusions are used to treat anemia and increase end-organ perfusion. Throughout their storage duration, LPRBCs undergo biochemical and structural changes collectively known as the storage lesion. These changes adversely affect perfusion and oxygen off-loading. Cryopreserved RBCs (CPRBC) can be stored for up to 10 years and potentially minimize the associated storage lesion. We hypothesized that CPRBCs maintain a superior biochemical profile compared with LPRBCs.

METHODS This was a prospective, randomized, double-blinded study. Adult trauma patients with an Injury Severity Score (ISS) greater than 4 and an anticipated 1-U to 2-U transfusion of PRBCs were eligible. Enrolled patients were randomized to receive either CPRBCs or LPRBCs. Serum proteins (haptoglobin, serum amyloid P, and C-reactive protein), proinflammatory and anti-inflammatory cytokines, d-dimer, nitric oxide, and 2,3-DPG concentrations were analyzed. Mann-Whitney U-test and Wilcoxon rank sum test were used to assess significance (p < 0.05).

RESULTS Fifty-seven patients were enrolled (CPRBC, n = 22; LPRBC, n = 35). The LPRBC group’s final interleukin 8, tumor necrosis factor α, and d-dimer concentrations were elevated compared with their pretransfusion values (p < 0.05). After the second transfused units, 2,3-DPG was higher in the patients receiving CPRBCs (p < 0.05); this difference persisted throughout the study. Finally, serum protein concentrations were decreased in the transfused CPRBC units compared with LPRBC (p < 0.01).

CONCLUSION CPRBC transfusions have a superior biochemical profile: an absent inflammatory response, attenuated fibrinolytic state, and increased 2,3-DPG. A blood banking system using both storage techniques will offer the highest-quality products to critically injured patients virtually independent of periodic changes in donor availability and transfusion needs.

LEVEL OF EVIDENCE Therapeutic study, level II.

From the Oregon Health and Science University, Division of Trauma, Critical Care and Acute Care Surgery, Trauma Research Institute of Oregon (D.A.H., L.J.F., L.K., J.D., S.U., D.L., J.W., M.A.S.); and Portland State University (C.W.),Portland, Oregon.

Submitted: December 5, 2013, Revised: February 9, 2014, Accepted: February 10, 2014.

This study was presented at the American College of Surgeons’ Committee on Trauma Meeting, March 21–23, 2013, in San Diego, California, where it received second place in the residents’ paper competition (clinical science). The study was also presented at the 27th Annual Scientific Assembly of the Eastern Association for the Surgery of Trauma, January 14–18, 2014, in Naples, Florida. Winner of the 2014 Raymond H. Alexander, MD Resident Paper Competition.

Address for reprints: David A. Hampton, MD, MEng, Oregon Health and Science University, Division of Trauma, Critical Care and Acute Care Surgery, Trauma Research Institute of Oregon (TRIO), 3181 SW Sam Jackson Park Rd, Mail Code L-611, Portland, OR 97239-3098; email:

© 2014 Lippincott Williams & Wilkins, Inc.