Effect of Duration of Packed Red Blood Cell Storage on Morbidity and Mortality in Dogs After Transfusion: 3,095 cases (2001-2010)

BackgroundAccumulating evidence suggests that transfusion of packed red blood cells (PRBCs) stored for >14days is associated with increased rates of sepsis, multiple organ dysfunction, and mortality in human patients. ObjectiveTo determine if duration of PRBC storage has an effect on morbidity and mortality in dogs after transfusion. AnimalsDogs admitted to the Matthew J Ryan Veterinary Hospital of the University of Pennsylvania. MethodsA retrospective case review of dogs identified through blood bank logbooks that received PRBC transfusions (minimum, 5mL/kg) between 2001 and 2010. Dogs were categorized according to major cause of anemia (eg, hemorrhage, hemolysis, ineffective erythropoiesis) for analysis. ResultsA total of 3,095 dogs received 5,412 PRBC units. Longer duration of PRBC storage was associated with development of new or progressive coagulation failure (P=.001) and thromboembolic disease (P=.005). There was no association between duration of PRBC storage and survival for all dogs overall. However, a logistic regression model indicated that for dogs with hemolysis, 90% of which had immune-mediated hemolytic anemia, longer duration of PRBC storage was a negative risk factor for survival. For every 7day increase in storage, there was a 0.79 lesser odds of 30day survival (95% CI, 0.64-0.97; P=.024). Conclusions and Clinical ImportanceDuration of PRBC storage does not appear to be a major contributing factor to mortality in the overall canine population. However, longer duration of PRBC storage may negatively impact outcome in dogs with immune-mediated hemolytic anemia, thus warranting further investigation with prospective studies.