Impact of Point-of-care Allogeneic Red Blood Cell Washing on Markers of Transfusion-related Respiratory Complications: A Phase II Randomized Clinical Trial.

Summary

In 154 cardiac surgery patients randomized to washed versus standard allogeneic red blood cells, point-of-care washing did not reduce lung injury biomarkers, alter cardiopulmonary responses, or improve ICU/hospital length of stay, ventilator- or oxygen-free days, or rates of TRALI/TACO and mortality. The negative results counter the premise that washing mitigates transfusion-related respiratory complications.

Key Findings

• No differences in recipient lung injury biomarkers between washed and standard RBC groups after cardiac surgery.
• ICU stay, hospital stay, ventilator-free and oxygen-free days were similar between groups.
• Incidence of TRALI, TACO, acute kidney injury, and mortality showed no significant differences.

Clinical Implications

Routine point-of-care washing of allogeneic RBCs in cardiac surgery should not be expected to reduce TRALI/TACO risk or improve recovery; focus should remain on evidence-based transfusion practices and risk minimization.

Limitations

• Nonblinded intervention may introduce performance bias
• Primary outcomes were intermediate biomarkers; study may be underpowered for rare clinical events

Future Directions

Focus on alternative strategies to mitigate transfusion-related lung injury and identify high-risk phenotypes; consider targeted trials powered for clinical endpoints.