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Author Notes:

Philip Norris, MD, Vitalant Research Institute, 270 Masonic Avenue, San Francisco, CA 94118. Email: pnorris@vitalant.org

PJN, JHL, AD, MES and PCS designed experiments; FT, GR, and SA designed data analyses; FT and GR performed data analyses; HCI, JWH, AD, and RV performed experiments; FS and SMK analyzed data; MS and AMG coordinated studies; and PJN, RMS, and PCS wrote the manuscript.

We thank Xin Sha and Shuo Li for performing initial statistical analyses. The following investigators and staff participated in patient enrollment and sample collection: Froedtert Memorial Lutheran Hospital, Milwaukee, WI: Z. Rashid (principal investigator), B. Alivo, J. McFarland, D. Nischick; Emory University Hospitals, Atlanta, GA: C. Josephson (principal investigator), M. Castillejo, K. Egan; Vanderbilt University Medical Center, Nashville, TN: P. Young (principal investigator), N. Bratcher, S. Dixon, J. Janssen, C. Madison, L. Michalowski; Robert Wood Johnston Medical School, New Brunswick, NJ: J. Carson (principal investigator), K. Dragert; Indiana Ohio Heart and St. Joseph’s Hospital, Fort Wayne, IN: V. Scavo (principal investigator), H. Downey, S. Eichman, S. James; St. Elizabeth’s Medical Center, Brighton, MA: R. Hunsaker (principal investigator), C. Keith, S. Lin, A. Weiffenbach, J. Wise; Aspirus Heart and Vascular Institute, Wausau, WI: R. Miles (principal investigator), J. Kaliebe, M. Johnson; K. Matsche; Sanford Heart Center, Fargo, ND: C. Dyke (principal investigator), D. Augustadt, J. Wurgler. This study was supported by NHLBI grants U01 HL072268-09S1 and R01 HL095470.

The authors have disclosed no conflicts of interest.



  • Science & Technology
  • Life Sciences & Biomedicine
  • Hematology

Effects of blood storage age on immune, coagulation, and nitric oxide parameters in transfused patients undergoing cardiac surgery

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Journal Title:



Volume 59, Number 4


, Pages 1209-1222

Type of Work:

Article | Post-print: After Peer Review


BACKGROUND: Retrospective studies suggested that storage age of RBCs is associated with inflammation and thromboembolism. The Red Cell Storage Duration Study (RECESS) trial randomized subjects undergoing complex cardiac surgery to receive RBCs stored for shorter versus longer periods, and no difference was seen in the primary outcome of change in multiple organ dysfunction score. STUDY DESIGN AND METHODS: In the current study, 90 subjects from the RECESS trial were studied intensively using a range of hemostasis, immunologic, and nitric oxide parameters. Samples were collected before transfusion and on Days 2, 6, 28, and 180 after transfusion. RESULTS: Of 71 parameters tested, only 4 showed a significant difference after transfusion between study arms: CD8+ T-cell interferon-γ secretion and the concentration of extracellular vesicles bearing the B-cell marker CD19 were higher, and plasma endothelial growth factor levels were lower in recipients of fresh versus aged RBCs. Plasma interleukin-6 was higher at Day 2 and lower at Days 6 and 28 in recipients of fresh versus aged RBCs. Multiple parameters showed significant modulation after surgery and transfusion. Most analytes that changed after surgery did not differ based on transfusion status. Several extracellular vesicle markers, including two associated with platelets (CD41a and CD62P), decreased in transfused patients more than in those who underwent surgery without transfusion. CONCLUSIONS: Transfusion of fresh versus aged RBCs does not result in substantial changes in hemostasis, immune, or nitric oxide parameters. It is possible that transfusion modulates the level of platelet-derived extracellular vesicles, which will require study of patients randomly assigned to receipt of transfusion to define.
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