The impact of storage time of packed red blood cells (RBCs) on patient outcome has been a topic of heated controversy. During the last two decades, 13 randomised controlled trials involving more than 5000 transfusion recipients were conducted to evaluate the effect of short-term storage versus long-term storage of RBCs in various populations including neonates, children, critically ill patients and cardiac surgical patients.

In the Informing Fresh versus Old Red Cell Management (INFORM) trial, more than 31 000 patients were randomised in a 1:2 ratio to receive RBCs that had been stored for the shortest period of time (mean 13 days) or the longest period of time (mean 23.6 days). The primary outcome was in-hospital mortality and the secondary outcome was the interval from hospital admission to in-hospital mortality. No significant difference in mortality between the short-term group and the long-term group was observed (P = 0.34).

The INFORM trial is informative, since it evaluates a general hospital population and was sufficiently powered to assess mortality. The trial evaluated more RBC recipients than the 13 previous trials together. The results of this trial support the current first-in, first-out practice of blood banks, which manage a resource that is already constrained.

– Rainer Moog

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