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Frozen Red Blood Cells are Safe and Effective: A Prospective Randomized Trial
Martin A Schreiber1, John B Holcomb2, Bryce Robinson*3, Joseph Minei4, Ronald Stewart5, Laszlo Kiraly*1, Belinda McCully*1, Bryan Cotton*6, Dina Gomaa*3, Michael W Cripps*4, Mark DeRosa*5, Samantha Underwood*1
1Oregon Health & Science University, Portland, OR;2Univrsity of Texas at Houston, Houston, TX;3University of Cincinnati, Cincinnati, OH;4University of Texas Southwestern, Dallas, TX;5University of Texas San Antonio, San Antonio, TX;6University of Texas at Houston, Houston, TX

Objectives: The utility of standard red blood cells (RBCs) is limited by an abbreviated shelf-life and worsening storage lesion with age. Cryopreserved red blood cells (CRBCs) are frozen 2-6 days after donation, stored up to 10 years and washed prior to use potentially providing a fresh and purified RBC product. We hypothesized that CRBC transfusion would be equivalent to RBC transfusion in stable trauma patients.
Methods: We performed a prospective, randomized, double blind study at 5 level 1 trauma centers. Stable trauma patients requiring transfusion were randomized to young RBCs (≤14 storage days), old RBCs (>14 storage days) or CRBCs. Tissue oxygenation (StO2), biochemical and inflammatory mediators were measured and clinical outcomes were determined.
Results: 256 patients were randomized (84 young, 86 old and 86 CPRBCs). The patients were well-matched for injury severity and demographics (p>0.2). Pre-transfusion and final hematocrits were similar (p>0.68). Patients randomized to CRBCs received 2 units compared to 4 in the other groups (p<0.001). Transfusion of old RBCs resulted in reduced StO2 while transfusion of CRBCs increased it (p<0.05). CRBCs contained significantly less α2-macrogobulin, haptoglobin, c-reactive protein, serum amyloid P, and free hemoglobin than the other groups (p<0.001). IL-2 was elevated in patients who received CRBCs compared to old RBCs (p=0.04). There was no difference in organ failure, infection rate or mortality between the groups (p>0.22).
Conclusions: Transfusion of CRBCs is at least as safe and effective as transfusion of young and old RBCs and results in a 50% reduction in transfused units and increased StO2.


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