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Standard blood bank practice is to release older units of red cells first (“first-in, first out”). Would acutely ill patients fare better if they were transfused with fresh rather than older blood?
To address this question, investigators conducted an international, multicenter, randomized, double-blind trial involving 4919 intensive-care patients who received a median of two red cell units of either fresh blood (stored for a mean of 11.8 days) or older, standard-issue blood (stored for a mean 22.4 days).
At 90-day follow-up, risk for death was similar with fresh versus older blood (24.8% and 24.1%, respectively), and was even higher with fresh blood for patients with APACHE III predicted risk for death ≥21.5% (37.7% vs. 34.0%; P=0.05). Other …