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Sat Jul 17 21:25:20 BST 2004

If the cytokine, bad cascade is already in max overdrive because of the
trauma insult: will old blood make it worse? will young blood make it
better?

R. Smith

  _____  

From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of KMATTOX at aol.com
Sent: Saturday, July 17, 2004 12:49 PM
To: trauma-list at trauma.org; ccm-l at list.pitt.edu; trauma-l at lists.aast.org
Cc: Redstart at aol.com
Subject: BANK BLOOD-21 Days old & OLDER

I was recently in Edinburgh Scotland at the International Blood Banking
Meeting.  I voiced an oft quoted concern from Trauma & Critical Care
physicians that older banked blood (>21 days):
    1.    Turned on cytokines more than fresh blood
    2.    Did not carry oxygen as well as fresh blood
    3.    Was higher in potassium and cellular debris

What the audience heard was that I was opposed to banked blood more than 21
days.  Actually, I do think that I stated that I would much rather have the
freshest blood possible when I have a patient who is massively bleeding, and
in the coagulopathic, hypothermic, acidotic patient, I have great concern
that old blood (21-35 days old) actually did a great deal in oxygen
transport, but was more of a volume expander in such patients.   You would
have thought that I had made a statement against motherhood, sainthood, and
all that is sacred.  One person really came after me with a vengeance.  I
stood my ground, admitted that this was more experiential than evidenced
based and asked in return if there is good class I or II evidence that in
the acidotic, hypothermic, and coagulopathic trauma patient, old blood
participates significantly in oxygen transport?    

THUS MY QUESTION TO THIS LIST SERVER?       Is the oft repeated emotion of
us that old banked blood (>21 days), is a volume expander and not of great
help in oxygen transport true or an urban legend?    I will look it up, of
course, but I thought it would be of great interest to this group to debate
and produce evidence on both sides of this issue as it is so very emotional.
I would like to see both the emotion, and the science, but please try to
indicate from which camp you emerge.

k
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BANK BLOOD-21 Days old & OLDER