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Transfusion of fresher versus older red blood cells in hospitalized patients: a systematic review and meta-analysis.
Blood. 2015 Dec 1;
Authors: Alexander PE, Barty R, Fei Y, Vandvik PO, Pai M, Siemieniuk RA, Heddle NM, Blumberg N, McLeod SL, Liu J, Eikelboom JW, Guyatt GH
Abstract
The impact of transfusing fresher versus older red blood cells on patient-important outcomes remains controversial. Two recently published large trials have provided new evidence. We summarized results of randomized trials evaluating the impact of the age of transfused red blood cells. We searched MEDLINE, EMBASE, CINAHL, the Cochrane Database for Systematic Reviews and Cochrane CENTRAL for randomized controlled trials enrolling patients who were transfused fresher versus older red blood cells and reported on outcomes of death, adverse events, and infection. Independently and in duplicate, reviewers determined eligibility, risk of bias, and abstracted data. We conducted random effects meta-analyses and rated certainty (quality or confidence) of evidence using the GRADE approach. Of 12 trials that enrolled 5,229 participants, 6 compared fresher red blood cells to older red blood cells and six compared fresher red blood cells to current standard practice. There was little or no impact of fresher versus older red blood cells on mortality (relative risk (RR) 1.04, 95% CI 0.94-1.14, p=0.45, I(2)=0%, moderate certainty evidence) or on adverse events (RR 1.02, 95% CI 0.91-1.14, p=0.74, I(2)=0%, low certainty evidence). Fresher red blood cells appeared to increase the risk of nosocomial infection (RR 1.09, 95% CI 1.00-1.18, p=0.04, I(2)=0%, risk difference 4.3%, low certainty evidence). Current evidence provides moderate certainty that use of fresher red blood cells does not influence mortality, and low certainty that it does not influence adverse events but could possibly increase infection rates. The existing evidence provides no support for changing practices towards fresher red blood cell transfusion.
PMID: 26626995 [PubMed - as supplied by publisher]