After a century of transfusions and approximately 100 million units of red blood cells (RBCs) transfused per year throughout the world,1 it is logical to expect that quality metrics for RBCs that directly reflect efficacy and broadly address safety exist. However, this is not the case. Current licensing criteria for RBC units do not require direct measures of efficacy as assessed by increased delivery of oxygen, which is concerning because increased delivery of oxygen is the purpose of transfusing RBCs for patients in shock (defined as oxygen debt or inadequate oxygen delivery to meet demand). Few data indicate that transfused RBCs of typical storage duration (more than 14 days for most patients) increase oxygen delivery to tissues or improve outcomes. In addition, licensing of RBC units does not require safety data. Even though the risks of transfusion-transmitted infectious diseases have decreased substantially, adverse effects related to the dysregulation of immune, vasoregulatory, and hemostatic systems with RBC transfusions continue to be reported.2,3
Spinella PC, Acker J. Storage Duration and Other Measures of Quality of Red Blood Cells for Transfusion. JAMA. 2015;314(23):2509–2510. doi:10.1001/jama.2015.14714
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