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Is Old Blood Bad Blood?

Researching the Shelf Life of Donated Blood
November 5, 2010

Dr. Steven Spitalnik and Dr. Eldad Hod

Donated blood is often called the “gift of life,” but some transfusions may do more harm than good.

“Thirty years ago we thought all transfusions were good, but after HIV got into the blood supply, we started to re-evaluate,” says Steven Spitalnik, MD, a transfusion medicine researcher and professor of pathology and cell biology at Columbia University College of Physicians and Surgeons.  “Now that the risks of infection have been dramatically reduced, other complications are becoming more noticeable.”

One aspect of blood transfusion that’s coming under more scrutiny is the length of storage time of banked red blood cells. Some studies in the past decade found that red blood cells stored for several weeks may be less beneficial than fresher blood, and may even harm critically ill patients.

The issue of “old” banked blood is now the topic of eight new NIH-funded research projects across the country, including one led by Dr. Spitalnik and Eldad Hod, MD, assistant professor of pathology and cell biology. 

Nobody knows yet why old blood may be risky – the new grants are the first to examine how stored blood may cause adverse effects – but Drs. Spitalnik and Hod’s research in mice suggests that a shot of iron that comes with old blood may be important.

“Certain bacteria love iron, and when exposed to it, they grow very rapidly,” Dr. Spitalnik says. “The concern with patients is that a spike in iron could transform an otherwise innocuous bacterial infection into a potentially deadly one.”

In recent trials with healthy human volunteers, Drs. Spitalnik and Hod see the same massive increase in iron that they see in mice after transfusions of old blood.

Whether that will exacerbate otherwise transient infections in people is still unknown. Their future studies with patients will help provide some answers.

In the meantime, though, changing the system to use only fresh blood would be highly problematic, Dr. Spitalnik says. “It would result in significant shortages and do more harm than good, because many people who need transfusions wouldn’t get them.”

“In the setting of severe blood loss, transfusions are safe and save many lives. What we’re trying to do is make them even safer,” Dr. Spitalnik says.

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