Banked Blood May Not Be As Effective As Hoped

URSpider alerts us to two separate research reports published in the Proceedings of the National Academy of Sciences pointing to the rapid breakdown of nitric oxide in donated blood as a reason why such blood loses its ability to transfer oxygen, and is sometime implicated in problems such as strokes and heart attacks. Nitric oxide depletion is significant after 3 hours of storage; yet current guidelines allow for storing donated blood for up to 42 days. The article notes: "Several of the researchers, including Stamler, have consulting and/or equity relationships with Nitrox/N30, a company developing nitric oxide based therapies."

Re:pros and cons

[Chris Burke]

Already hospitals prefer to use fresh blood in transfusions, and when they can predict the need they get fresh blood when possible. I myself have been called by the local Blood & Tissue Center to donate blood for a child's operation that was going to be performed the next day. It wasn't a general supply issue; my blood type is A+, the second most common in the U.S. and when I asked they said they had plenty. It's just that since they knew of the need in advance they could afford to take the time to call me up for some of my fresh blood.

If the results of this study bear out, then it may just mean that hospitals are even more likely to try to get a fresh donation prior to any surgery that may require a transfusion. E.R. is still going to have to deal with whatever supply they have on hand when someone comes through the doors, though maybe there are procedural changes they can make to help ensure that they use newer blood by preference?

Re:pros and cons

[nursegirl]

From Time:

The trend affects almost every group of critically ill patients -- from trauma sufferers in the ER to heart attack victims, patients with anemia and those undergoing chemotherapy. ... "After you control for sickness and all sorts of things, patients who receive transfusions still have more heart attacks. It makes no sense," says Dr. Jonathan Stamler, a professor of medicine at Duke University Medical Center.

It'll be interesting to see whether the research proves that oral nitrates will be effective. The Time article mentioned that mouse studies have shown that adding NO to blood given to mice reduces their likelihood of cardiac complications. I haven't been able to get at the original journal article yet, though.

Donating to Yourself

[Doc Ruby]

"Autologous" donations are donations extracted from you when you're healthy enough, like in advance of surgery, for use later, like when you need it during/after surgery. Currently, it's infrequent, and suffers from the same problems (possibly) identified by this study after a while.

But if you donated blood in advance of surgery, and it were used within a few hours, you could get a credit for blood later on when you need it urgently. If everyone scheduled for surgery were required to donate blood in advance (if they were healthy enough to do so), there would be so much blood available all the time that the fresh stuff would never be in short supply.

The infrastructure is in place right now. The techniques are nearly the same, just a tiny little DB and fridge shuffling to keep the fresh stuff flowing, and discard the extra as it ages.

All that's required to permanently end the incessant "blood shortages" and blood drives that could work on something else instead, would be making these donations a requirement.

Re:pros and cons

[sjames]

ays that 25% of blood donor recipients have heart attacks within the 30 days post-transfusion, as opposed to 8% of patients who came in to the emergency with similar conditions, but did not get a blood transfusion.

First, those figures apply only to heart disease patients, so are likely on the edge anyway. The stats presented do need to be looked at, but there can be many reasons for the differences that have nothing to do with NO levels. For example, increasing the blood viscosity (by adding red blood cells) can strain the heart.

It could be flaws in the study. For example, patients who need blood to improve oxygenation have been inadequately oxygenated before. That may be the root cause.

Alternatively, if it IS the NO levels, nitroglycerine is dirt cheap in comparison to any new drug and may be just as effective.

We won't actually know until double blind studies are done.