Consideration of reducing the shelf life of SAGM RBCs Dana Devine, PhD Chief Medical & Scientific Officer May 4, 2017

RBC storage limits SAGM Red Cells Storage limit of RBC storage systems licensed in Canada is 42 days. Other blood operators have voluntarily limited storage of RBC in SAGM to 35 days to ensure hemolysis specifications are met. EU member countries NIH Clinical Center Transfusion Service (Dr. Harvey Klein) Hemolysis rates in AS-3 stored RBC are lower than SAGM RBC.

Are RBCs stored for 35-42 days of concern? RBC storage limits Are RBCs stored for 35-42 days of concern? Animal studies (rodents, dogs) suggest that the free hemoglobin levels in week 6 may release enough iron to promote bacterial sepsis. Large database analyses (eg TRUST) have not identified problems with blood in the last week of storage. No RCT data exist due to ethical concerns.

RBC storage limits Accumulating data suggest that RBCs in the last week of storage may be problematic

RBC Storage Limits A single unit of 6 week old RBC overwhelms normal iron binding capacity in health volunteers Circulating non-transferrin bound iron was detected in 7/9 normal volunteers transfused with 6 week old blood, and 1/10 donor receiving 5 week old blood. Rapido et al. JCI 2017

Effects of Aged RBC Transfusion RBC storage limits Effects of Aged RBC Transfusion Lee JS, Kim-Shapiro DB. JCI 2017

Should we consider a voluntary reduction of storage time to 35 days? RBC storage limits Should we consider a voluntary reduction of storage time to 35 days? Simulations of inventory management suggest no impact on wastage of 35 day outdating (Blake et al) Consideration needs to be given to models that include redistribution programs.