How old the pack cell can be used

Dear All
Pl help me in understanding that how old that pack cell can be used. In our blood bank, we are ,at times ,gven blood which is  as old as 30 days. They say that the expiry date is 40 days from date of collection. My question is that will this blood be as effective as the fresh blood . Are we doing the right thing by transfusing this blood.
what is the way out. Feeling helpless. The gene therapy is also lookig like distant dream and on top of that these blood related issues.
Rgds

Dear Andy
 Request someone you to answer my query, please.

Blood can keep for up to 40 days. Practical experience tells us that the fresher the blood, the longer its life will be in the recipient's body. Sometimes you have no choice. Older blood may not be quite as effective, but it is still useful. One way to avoid this is to arrange a group of donors, so that blood can be made available when needed.

Andy...my daughter goes to CHOP every 3 weeks (on fridays) for her transfusions. The last 2 times she has had a high fever the day after which lasted a few days and reached a temp of 103. Could this be a result of the blood used? Im interested in knowing how old the blood is that they use at CHOP.

Thanks,

James

Thanks Andy for the clarification. One of my observation is that when the blood is frsh the spleen size of my son reduces and when it is not so , it usually becomes hard.

Andy

cane you tell me whool blood is good are washed blood are with leukocyte filter.

Whole blood shouldn't be used if possible because it can cause transfusion reaction easily. Filtered packed red cells are preferred.

James,

Fever after transfusion is often an antibody reaction to the transfused blood. The main problem with these reactions is that they tend to make the transfused blood break down faster, thus requiring transfusions sooner. Can the fever be related to the age of the blood? Sounds like a good subject for study. Studies in recent years that measured the age of the blood used in transfusions for patients going through heart surgery, showed that newer blood led to far fewer complications. I don't think you can extrapolate anything specific about this is regards to the transfusion dependent, but it is well known that the fresher the blood, the better its oxygen carrying capability, so the fresher the better. I would check with CHOP about how old the blood is when transfused. There is an interesting article at
http://newswise.com/articles/researchers-discover-why-stored-blood-may-become-less-safe-for-transfusion-as-it-ages

Researchers Discover Why Stored Blood May Become Less Safe for Transfusion as It Ages

Released: 7/15/2011 2:30 PM EDT
Source: Wake Forest University
Newswise — Every two seconds, someone in the United States needs blood. In fact, more than 5 million Americans receive blood transfusions each year, according to the American Red Cross.

Depending on the amount and age of the stored blood used, there is evidence that transfusion can lead to complications including infection, organ failure and death. New research from Wake Forest University and the University of Pittsburgh School of Medicine found that these complications are likely due to red blood cell breakdown during storage, implying that transfused blood may need to be stored in a different way. This week in the early online version of Circulation, the team reports the latest findings from its ongoing exploration of the interaction between red blood cell breakdown products and nitric oxide (NO), revealing new biological mechanisms that can reduce blood flow and possibly damage vital tissues after administration of blood that has been stored for longer periods of time.

In recent years, doctors have noted that transfusion of either many units of blood or of blood stored a long time may be associated with a greater frequency of complications, such as increased infection risk, kidney, lung or multi-organ failure and death, particularly among medically vulnerable patients, explained senior investigator Mark T. Gladwin, M.D., chief, Division of Pulmonary, Allergy and Critical Care Medicine, Pitt School of Medicine, and director of Pitt’s Vascular Medicine Institute. Gladwin worked on the study with senior author Daniel B. Kim–Shapiro, Ph.D., professor of physics and director of the Translational Science Center at Wake Forest.

“When blood sits for a while, some of the cells break down and release their contents, which include molecules of hemoglobin and red blood cell microparticles,” Dr. Gladwyn said. “These accumulate in the stored bag of blood and are transfused into the patient with the blood. In the bloodstream, the hemoglobin and microparticles bind to and destroy NO, a very important molecule that is used by the body to keep blood vessels dilated for normal blood flow.”

The scavenging of NO causes blood vessel constriction that can prevent tissues and organs from getting adequate oxygen and activate the platelets and the coagulation system, as well as cause inflammation, the researchers said.

From their experiments, they found that human blood stored under standard conditions accumulated “free” hemoglobin that was no longer contained in a cell and microparticles of damaged cells. Those breakdown products reacted with NO about 1,000 times more quickly than did intact red blood cells. Also, transfusion of even very low concentrations of hemoglobin caused blood vessel constriction and hypertension in a rat model.

“Avoiding the storage lesion, as it is referred to in our field, could require a new approach to how donor blood is stored prior to transfusion,” Kim-Shapiro said.

“Transfusion of stored blood is one of the most common medical therapies,” he said. “By understanding the mechanism of the storage lesion, we can design methods to make blood transfusion safer. For example, perhaps we can restore nitric oxide activity that is lost upon transfusion, use preservation solutions that better limit the degradation of blood cells, or develop agents that scavenge free hemoglobin.”

Other research projects are underway to find approaches to correct the problem, and to assess the safety of blood for transfusion that has been stored for longer than 14 days. Currently, federal guidelines allow transfusion of blood that has been stored for up to 42 days.

The team includes lead authors Chenell Donadee, M.D., Nicholas J.H. Raat, Ph.D., Albert B. Donnenberg, Ph.D., and Darrel Triulzi, M.D., all of Pitt; and Chen Liu, Hannah Reynolds, and Ivan Azarov, Ph.D., all of Wake Forest.

The study was funded by the National Institutes of Health, the Institute for Transfusion Medicine, and the Hemophilia Center of Western Pennsylvania.

Thanks Andy...will look into it

Andy

Thanks alot for your reply and hows is washed red blood cell .

Andy..just spoke with the nurses and Doctors at CHOP...they stated their blood is fine and my daughters fever's the last 2 times was just a coincidence. Dont fell releaved at all which is usual...however they stated that they will introduce Benidril with the IV next time. I know this is common but I feel it is lazy.

James,

Benadryl is commonly used during transfusions. Lisa always got it during her transfusions. It would make her sleepy but it did help prevent the minor reactions caused by transfusion. It's definitely worth trying.