Researchers compared outcomes for patients with transfusion-dependent thalassemia (TDT) based on the use of a fresh blood product vs a stored blood product. They found nonsignificant increases in hemoglobin with fresh blood, but significantly higher white blood cell (WBC) counts and C-reactive protein levels with stored blood. The study results were published in the American Journal of Blood Research.

As the study investigators noted in their report, patients with TDT often require many blood transfusions over their lifetimes, but blood supplies may be limited. Blood products like red cell concentrate (RCC) may be stored for up to 42 days prior to being used in a transfusion. However, as the investigators explained, these stored cells may undergo physiological changes that could potentially promote hemolysis.

The study was based at Khyber Medical University in Peshawar, Pakistan. In this study, patients with TDT initially received RCC that had been stored for <2 days (“fresh” RCC), and on a second visit 15 days after the first visit, they received RCC that had been stored for 7 days (“stored” RCC). The researchers collected blood samples from patients just prior to each transfusion, as well as at 24 hours posttransfusion, for evaluations of multiple hematologic and biochemical parameters.

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A total of 20 patients with TDT were included in the analysis. Compared with the use of stored RCC, transfusions involving fresh RCC were associated with increases in hemoglobin at 24 hours, but not to a statistically significant degree. The mean+SD increases in hemoglobin levels after transfusions were 1.55+0.64 g/dL vs 1.35+0.46 g/dL for fresh vs stored RCC, respectively (P =.543).

Other red blood cell parameter changes were also similar with the use of fresh vs stored RCC. Mean posttransfusion WBC counts, however, were significantly higher after transfusions with stored RCC (1.82×109 cells/L increase) than with fresh RCC (1.01×109 cells/L increase; P =.002). Posttransfusion increases in C-reactive protein levels were also significantly higher with the use of stored RCC (6.43+7.46 mg/dL increase) than with the use of fresh RCC (1.89+2.38 mg/dL increase; P =.012).

Serum iron levels were increased in patients with both fresh and stored RCC, but without significant differences between fresh and stored RCC (P =.18). A similar pattern was seen with increased serum ferritin levels after transfusion, but without significant differences between fresh and stored RCC (P =.55). Changes in levels of lactate dehydrogenase, direct bilirubin, indirect bilirubin, creatinine, blood glucose, and serum uric acid were also not significantly different with the use of stored or fresh RCC.

“We demonstrate that transfusion of 7-days stored RCC is associated with rise in markers of inflammation (WBC counts and C-reactive protein),” the study investigators wrote in their report.


Naeem U, Baseer N, Khan MTM, Hassan M, Haris M, Yousafzai YM. Effects of transfusion of stored blood in patients with transfusion-dependent thalassemia. Am J Blood Res. 2021;11(6):592-599.