Heart surgery patients who received transfusions of blood stored for more than two weeks were 64% more likely to die in the hospital than those who received fresher blood, a finding that adds to the growing concern about the safety of transfusion practices.
Several small studies have already suggested a danger in using blood that is nearing its expiration date, but a report to be published Thursday is by far the largest, with more than 6,000 patients enrolled.
In response to the growing concern, some hospitals have modified their procedures for cardiac surgery - one of the largest consumers of donor blood - to minimize the need for transfusions.
New practices include increased use of blood scavenging during surgery, sending patients home with a lower-than-normal percentage of red cells in their blood, new drugs to prevent intra- and post-operative bleeding and, perhaps most important, reducing anemia before surgery.
Some researchers are also attempting to rejuvenate older blood by reinfusing it with nitric oxide, a crucial ingredient for delivering oxygen to tissues that has been shown to disappear during storage.
Many of the conservation techniques were originally developed because of fears about AIDS and other infectious agents in blood, but they have become doubly important now because of concerns about the blood itself, said Dr. Richard Shemin, chief of cardiothoracic surgery at UCLA's Geffen School of Medicine.
"We now have very good data that shows being exposed to any blood does have a potential for harm," he said.
But any regulatory changes are unlikely in the near future.
A statement today by the Food and Drug Administration noted that the new study in the New England Journal of Medicine was "narrow and non-randomized," and that any regulatory actions would be "premature."
And any action to reduce the shelf life of donor blood would significantly impair supplies, said Dr. Ross Heron, medical director of the American Red Cross. "I don't know if we would be able to get enough blood donors to offset that," he said.
More than 14 million units of blood are transfused every year in the U.S. Regulations let it be stored for as long as six weeks, which allows time to ship it across the country and provides a cushion against shortages. Most blood banks operate on a "first in, first out" basis, so that patients typically receive the oldest blood available. The median storage time of transfused blood is 15 days.
