Latest study debunks age of red cell advantage

Results from the ABLE (Age of Transfuse Blood in Critically Ill Adults) study have just been published in the New England Journal of Medicine.

This study is an important milestone in the debate around the value of “fresh blood”. For several years now there has been increasing evidence of differences in stored blood with time: the longer red cells are stored, the more measurable changes occur. It has been assumed that this red cell storage lesion has negative clinical consequences. Indeed, several observational studies strongly suggested that older blood had deleterious effects.

The ABLE study compared key outcomes –  in particular 90-day mortality –  for critically ill patients in 64 hospitals across Canada and Europe. Patients were randomised to receive <7 day old blood or standard transfusion. The patient groups were very closely matched and the groups received either 6.1 day old or 22 day old red cells for transfusion. The primary outcome found no difference in the 90-day mortality between the groups. Secondary outcomes such as major illness, length of stay, transfusion reactions etc also found no difference between the study groups.

The ABLE study now sits beside the other large randomised trials in this area: the ARIPI study (Fergusson et al), which found no advantage of fresh blood in sick premature babies and the RECESS study (Steiner et al), which found no difference in cardiac surgical patients.

Together these studies are building evidence that the red cell storage lesion is not very important in some clinical situations. We should note that only very sick patients have been studied in these large trials and the results may not be generalisable.

There are other high quality studies still ongoing in this field, in particular the Australian TRANSFUSE study and the Canadian-Australian INFORM study.

For my clinical practice, I am becoming progressively reassured that I don’t need to ask for young blood compared to standard, especially in the setting of ICU.

Dr Ben Saxon is the National Transfusion Specialist at the Australian Red Cross Blood Service and haematologist at the Women’s and Children’s Hospital, Adelaide.

Quick transfusion quiz for busy health professionals

Transfusion Q&A is a database of questions, grouped by topic, designed to test your knowledge of safe transfusion practices and patient blood management. We made it specifically for the time poor (that would be all of us, then).

You can access Transfusion Q&A at Alternatively you can access individual topics on Transfusion Online Learning on

You choose how you complete a topic: all in one hit as a “quick quiz”; or enrol to get sent questions over time. You choose the device on which you access the education – PC, laptop, mobile phone, or tablet.

If you enrol, the system sends notifications when questions are due to be answered. During enrolment you choose to receive these via email or SMS. You can also choose to customise delivery notifications, indicating how many questions you want to receive with each notification and how often you get the notifications.

But don’t worry if you can’t be bothered with the customisation – we have pre-set a delivery schedule for you.

Every time you answer a question you get feedback on your response and an explanation with links to the relevant information about the topic.

If you want to receive a certificate for CPD purposes, enrol in a topic. You’ll need to get each question correct twice to be awarded a certificate – there are no rewards for random guessing in this game.

If you think you already know your stuff, but just want to confirm this, do a quick quiz. You’ll still get instant feedback on the answers to your questions and a score at the end, but no certificate.

Once you log into Transfusion Q&A, your dashboard will list the topics you are currently enrolled in and those you have completed, with links to your certificate.


– Dr Sandy Minck