Transfusion in children

BY Elizabethe Holland Durando

Washington University School of Medicine has received a $7.8 million grant to determine whether the length of time red blood cells (RBCs) are stored affects organ failure in critically ill children who receive RBC transfusions.

The five-year grant, from the National Heart, Lung and Blood Institute of the National Institutes of Health (NIH), will fund a trial involving more than 1,500 critically ill children who require RBC transfusions at St. Louis Children’s Hospital and some 30 other medical centers in the U.S. and Canada. The trial will be one of the largest studies performed in pediatric critical care.

“We want to know whether fresh red cells can improve outcomes in critically ill children,” said Philip Spinella, MD, associate professor of pediatrics at the School of Medicine and a principal investigator in the study. "No studies have evaluated whether storing RBCs for more than a week affects clinical outcomes for these children.”

The researchers will compare the risk of new or progressive multiple organ failure in two groups of critically ill children ages 3 days to 16 years randomly assigned to receive RBC transfusions as a course of treatment. One group will receive RBCs stored for a week or less, and the other will receive RBCs stored an estimated average of 21 days.

Generally, patients who require RBC transfusions receive cells stored anywhere from three to 42 days. The standard approach is to use those stored the longest first.