Standard-issue red-blood-cell transfusions no less effective than fresh red blood

Written by Celeste Brady

An international study has observed no significant difference in risk to critically ill children who receive standard-issue red-blood-cell transfusions compared to those who receive fresh red blood cells, contrary to some hospital policies.

Published on Tuesday, the results of the Age of Blood in Children in Pediatric Intensive Care Units (ABC-PICU) randomized trial — conducted over nearly 5 years — show no significant effect of the age of transfused blood on organ dysfunction in critically ill children. The study, which was published in the Journal of the American Medical Association, is the first to examine the clinical consequences of red blood cell storage age for critically ill pediatric patients in a large, randomized trial.

Some hospitals preferentially use fresh red blood cells in critically ill pediatric patients, based on studies suggesting older red blood cells might be less efficient at oxygen delivery and adversely affect vital mechanisms in the body. The results of this study do not support this practice, which could alleviate pressure on blood banks by reducing the need for fresh red cells.

The findings agree with earlier randomized trials in critically ill newborns, children with severe anemia and adults. This will reassure healthcare practitioners that the use of the oldest blood in storage — up to 42 days old — is just as safe as fresh blood, improving the efficient use of blood banks.

In the study, 1538 intensive care patients, aged 3—16 years, were randomly allocated to groups receiving either fresh red blood cells or standard-issue, older red-blood-cell transfusions. Organ dysfunction, which the study deemed the most relevant primary outcome due to its correlation with mortality or quality of life, was monitored for 28 days after transfusion, unless patients died or were discharged.

The unadjusted risk difference for organ dysfunction between the treatment-receiving groups was 2%; this demonstrates that there were no significant differences in organ dysfunction syndrome between individuals who received fresh versus standard-issue red blood cells.

Spanning centers in the USA, Canada, France, Italy and Israel, the diversity of the study population, along with the sample size, suggests the results will be relevant to the general pediatric population.

The study’s co-principle investigator, Philip Spinella (Washington University School of Medicine; MO, USA) , noted the impact the findings may have on hospital policies: “Our findings indicate that doctors should not be afraid to use older red cells in critically ill children. Those who are showing a preference for fresh red cells might consider discontinuing this practice unless there are extenuating circumstances.”


Spinella PC, Tucci M, Fergusson DA et al. Effect of fresh vs standard-issue red blood cell transfusions on multiple organ dysfunction syndrome in critically ill pediatric patients. JAMA. 322(22); 2179—2190; (2019);