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Colombian Journal of Anestesiology

versión impresa ISSN 0120-3347

Rev. colomb. anestesiol. vol.41 no.1 Bogotá ene./mar. 2013


Blood storage and transfusion

Almacenamiento sanguíneo y transfusión

Daniel Rivera Tocancipaa

a Transplant Anesthetist, Training in Pediatric Anesthesia, Epidemiologist, Assistant Professor, Health School, Anesthesiology and Resuscitation Service, Universidad Surcolombiana, Neiva, Colombia

Correspondence address: Calle 9 con Carrera, 14. Neiva, Huila,

As concerns the Reflection Article “Blood Storage and Transfusion Injury”1 written in relation with the article entitled “Blood Sparing Techniques in Surgery”2that proposes that a bank blood undergoes “storage” alterations leading to worse outcomes when “old” units are transfused, it is worth highlighting that studies with intermediate outcomes such as lung dysfunction, have not found statistical differences between transfusions using blood with different storage times, in particular in the ICU3, 4; while other studies report alterations, particularly in mass transfusions and trauma cases. Although the controversy still persists, it is important to transfuse blood with the least storage time. Some references that contribute to the discussion and that involve other blood products such as platelets are included below 5, 6, 7, 8, 9.

In terms of Hb levels of 6 and 10g/dl, there is no consensus as to the absolute need to use them as a basis for deciding about transfusions. However, clinicians’ tools are to elucidate the patient's situation and, consequently, I believe that the phrase taken from the American Society of Anesthesiologists (ASA Task Force) is accurate: “The decision between 6 or 10g/dl is an individual decision and must be based on clinical and paraclinical parameters pointing to tissue hypoperfusion”.5 This means that the signs of hypoperfusion need to be taken together with the Hb value, and this would be a reasonable and practical recommendation, despite the fact that it may still be subject of debate.

Finally, based on the evidence, I share the “restrictive” approach to transfusion.

1. Aristizabal JP. La lesión por almacenamiento y la transfusión sanguínea. Rev Colomb Anestesiol. 2012;40:266-7.         [ Links ]

2. Rivera D, Pérez A. Técnicas de ahorro sanguíneo en cirugía. Rev Colomb Anestesiol. 2011;39:545-59.         [ Links ]

3. Kor DJ, Kashyap R, Weiskopf R, Wilson GA, Van Buskirk C, Winters J. Fresh red blood cell transfusion and short-termpulmonary, immunologic, and coagulation status: a randomized clinical trial. Am J Respir Crit Care Med. 2012;185:842-50.         [ Links ]

4. Weiskopf RB, Feiner J, Toy P, Winford J, Shimabukuro D, Lieberman J. Fresh and stored red blood cell transfusion equivalently induce subclinical pulmonary gas exchange deficit in normal humans. Anesth Analg. 2012;114:511-9.         [ Links ]

5. American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion, Adjuvant Therapies. Practice Guidelines for Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology. 2006;105:198-208.         [ Links ]

6. Welsby IJ, Lockhart E, Phillips-Bute B, Campbell ML, Mathew JP, Newman MF, et al. Storage age of transfused platelets and outcomes after cardiac surgery. Transfusion. 2010;50:2311-7.         [ Links ]

7. Lelubre C, Piagnerelli M, Vincent JL. Association between duration of storage of transfused red blood cells and morbidity and mortality in adult patients: myth or reality? Transfusion. 2009;49:1384-94.         [ Links ]

8. Ranucci M, Carlucci C, Isgrò G, Boncilli A, De Benedetti D, De la Torre T, et al. Duration of red blood cell storage and outcomes in pediatric cardiac surgery: an association found for pump prime blood. Crit Care. 2009;13:R207.         [ Links ]

9. Gajic O, Rana R, Mendez JL, Rickman OB, Lymp JF, Hubmayr RD, et al. Acute lung injury after blood transfusion in mechanically ventilated patients. Transfusion. 2004;44:1468-74.         [ Links ]