Massive Transfusion Protocol Activation Does Not Result in Preferential Use of Older Red Blood Cells

Widespread, anecdotal belief exists that patients receiving massive transfusion, particularly those for whom a massive transfusion protocol (MTP) is activated, are more likely to receive older red blood cells (RBCs). Retrospective review of blood bank records from calendar year 2011 identified 131 patients emergently issued ≥10 RBC units (emergency release (ER)) prior to obtaining a type and screen. This cohort was subclassified based on whether there was MTP activation. For comparison, 176 identified patients transfused with ≥10 RBC units in a routine fashion over 24 hours represented the nonemergency release (nER) cohort. Though the median age of ER RBCs was 5 days older than nER RBCs (ER 20, nER 15 days, ), both fell within the third week of storage. Regardless of MTP activation, transfused ER RBCs had the same median age (MTP 20, no-MTP 20 days, ). In the ER cohort, transition to type-specific blood components increased the median age of transfused RBC units from 17 to 36 days ( ). These data refute the anecdotal belief that MTP activation results in transfusion of older RBCs. However, upon transition to type-specific blood components, the age of RBCs enters a range in which it is hypothesized that there may be a significant effect of storage age on clinical outcomes. 1. Background The influence of duration of storage of red blood cells (RBCs) on clinical outcomes is currently unknown. Multiple retrospective and observational studies suggest that transfusion of older RBCs, particularly in trauma patients, is associated with increased morbidity including multiple organ failure and nosocomial infection [1–6]. However, the inherent limitations of the study designs of these analyses weaken the conclusions. Furthermore, other authors contend that there is no increase in complication rates attributable to RBC duration of storage [7–10]. The age of stored RBCs in massive transfusion has received particular interest. Most blood banks in the United States practice a “first-in-first-out” inventory policy, which could potentially result in the delivery of large volumes of older RBCs to massively hemorrhaging patients [11–13]. Some have hypothesized that patients receiving massive transfusion, particularly trauma patients, are more likely to receive older RBCs than other patients requiring transfusion [4]. Despite the concern regarding the age of RBCs transfused to patients with massive hemorrhage, there are no studies specifically designed to address whether the use of a massive transfusion protocol (MTP) results in the delivery of older RBCs. Furthermore,