Effect of transfusion of red blood cells with longer vs shorter storage duration on elevated blood lactate levels in children with severe anemia: the TOTAL randomized clinical trial.

Over the past few years, the “age of blood” has been one of the hot topics discussed regularly during meetings and in several publications. However, it has to be pointed out that despite the wide interest in this topic no consensus has been reached yet. Studies with many different, partially inconsistent designs (e.g. overlapping storage durations in different study arms) have led to conflicting results.

Dhabangi and colleagues now present a study with a crystal-clear protocol (no overlapping storage durations in both study arms), a clear hypothesis (non-inferiority) and distinct results (no difference). However, it remains unclear whether these results are generally applicable: the patients treated with blood transfusions were children with malaria or sickle cell disease. Due to the specific rheological changes, the results found by Dhabangi et al. might not hold true for the haemorrhagic, dilutional anemia commonly seen in European/US clinical settings.

In summary, we now know that the age of blood probably does not matter in malaria or sickle cell disease, but whether there is a difference in bleeding patients remains open for discussion.

– Jens Meier