Age of Red Cells for Transfusion and Outcomes in Critically Ill Adults

Cooper DJ, McQuilten ZK, Nichol A et al. for the TRANSFUSE Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group

New England Journal of Medicine 2017; 377:1858-67.

Aim of Study

To determine whether the duration of red-cell storage affects mortality after transfusion among critically ill adults.

Design and Location

International, multicentre, randomized, double-blind, parallel-group trial (Australia, New Zealand, Ireland, Finland, Saudi Arabia)


Randomly assigned patients received either the freshest, compatible, allogeneic red-cell units available from the transfusion service (short-term storage group) or the oldest available, compatible, allogeneic red-cell units (long-term storage group).

Primary Outcome

90-day all-cause mortality after transfusion.

Secondary Outcomes

  • 28-day mortality
  • persistent organ dysfunction or death at day 28
  • days alive and free of mechanical ventilation at day 28
  • days alive and free of renal-replacement therapy at day 28
  • new bloodstream infection in the ICU
  • febrile nonhemolytic transfusion reactions
  • length of stay in the hospital and in the ICU
  • quality of life at day 180 after randomization


  • All analyses in accordance with a predefined analysis plan.
  • Compared the primary outcome of 90-day all-cause mortality using an unadjusted chi-square test.
  • Conducted sensitivity analyses using hierarchical multiple logistic regression.
  • Assessed the duration of patient survival using Cox proportional-hazards regression.
  • Visually assessed the proportional-hazards assumption across treatment groups using log-cumulative hazard plots.
  • Present survival results as Kaplan–Meier survival curves with a corresponding log-rank test for equality of survivor functions across treatment groups.


Death at 90 days – no significant difference

Short-term storage 24.8%. Long-term storage 24.1%. unadjusted OR 1.04 (0.91-1.18, p=0.57), adjusted OR 1.05 (0.92-1.21, p=0.46)


This study confirms that there is no benefit gained from using the freshest blood available in the blood bank for transfusing critically ill patients. Conversely it also confirms that there is no harm from using the oldest blood in the blood bank to transfuse critically ill patients

Stated Limitations from the Study

  • 1353 eligible patients did not undergo randomization.
  • The finding of more febrile non-haemolytic reactions in the fresh blood group should be considered exploratory.
  • The finding of higher mortality in the sicker patient group is of unknown significance.

Discussion from Journal Club Meeting

Value of study: Is fresh blood is always the best?

  • The unexpected higher mortality with short term group in 28 days follow up is insignificant. However, the febrile non haemolytic reactions difference is and needs further follow up.
  • Need a review with the local blood bank team to discuss if they have different protocol for using differently aged PRBCs.
  • The finding of higher mortality in the sicker patient group is of unknown significance

Summary by Dr A Abdelhalim. Journal Club Meeting 28th February 2019.

Comments are closed.

Blog at

Up ↑

%d bloggers like this: