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The Plain Dealer, March 2008

Cleveland Clinic study raises questions about shelf life of blood

It's not something you think to ask your surgeon: What's the expiration date of the blood that might be transfused into my body?

But more people may be asking, in light of a new Cleveland Clinic study that raises questions about the shelf life of donated blood.

The study involving 6,002 heart surgery patients over eight years found that those who were given blood that had been stored more than 14 days suffered more complications and deaths than those given fresher blood.

The Food and Drug Adminis tration allows refrigerated blood to be stored up to 42 days for transfusion.

The reasons older blood was linked to worse outcomes are not clear, said the report in today's New England Journal of Medicine. Patients given the older blood were more likely to experience kidney failure and blood infections.

Studies have conflicted on whether blood of a certain age is riskier for patients, so the Clinic research — though possibly the largest body of work — does not settle the matter. It's also not clear whether the results apply to patients other than those studied, who underwent heart bypass or valve surgery.

Dr. Colleen Gorman Koch, the lead author, said the hospital is pursuing a random, controlled study of about 2,000 patients that could change the guidelines on shelf life.

In the meantime, Koch said patients can take steps to protect themselves:

Ask about the likelihood of needing a transfusion during surgery. Work with your surgeon to manage anemia, and reduce the chance of needing a transfusion.

Ask about blood-conservation strategies. Medications can stimulate red-cell production and reduce bleeding and technologies can salvage blood lost in surgery.

With constant shortages of blood donations, hospitals face immense challenges in managing inventory, Koch said. American Red Cross blood supplies are often down to a day or two in this area.

"You've got a supply that's unpredictable, you've got a product that expires and you can't always predict the need," she said.

Dr. Suneeti Sapatneker, medical director of Red Cross Northern Ohio Blood Services, said the Clinic study raises important questions about whether something happens to stored blood that is harmful to some patients.

But, she said, "Our biggest problem at this time is not related to can we provide fresh blood to people, but can we provide blood at all?"

Studies have conflicted on whether blood of a certain age is riskier for patients, so the Clinic research — though possibly the largest body of work — does not settle the matter. It's also not clear whether the results apply to patients other than those studied, who underwent heart bypass or valve surgery.

Dr. Colleen Gorman Koch, the lead author, said the hospital is pursuing a random, controlled study of about 2,000 patients that could change the guidelines on shelf life.

In the meantime, Koch said patients can take steps to protect themselves:

Ask about the likelihood of needing a transfusion during surgery. Work with your surgeon to manage anemia, and reduce the chance of needing a transfusion.

Ask about blood-conservation strategies. Medications can stimulate red-cell production and reduce bleeding and technologies can salvage blood lost in surgery.

With constant shortages of blood donations, hospitals face immense challenges in managing inventory, Koch said. American Red Cross blood supplies are often down to a day or two in this area.

"You've got a supply that's unpredictable, you've got a product that expires and you can't always predict the need," she said.

Dr. Suneeti Sapatneker, medical director of Red Cross Northern Ohio Blood Services, said the Clinic study raises important questions about whether something happens to stored blood that is harmful to some patients.

But, she said, "Our biggest problem at this time is not related to can we provide fresh blood to people, but can we provide blood at all?"

Harlan Spector

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