Grant: Operating Grant

Hundreds of thousands of Canadians and many million persons worldwide receive a red cell blood transfusion each year. Blood Banks normally issue the oldest available blood, thereby avoiding wastage of stored red cells that exceed the approved shelf-life of 42 days. However, several recent studies have suggested that standard issue (oldest available blood) compared with fresh blood increases the risk of adverse outcomes, including infection, organ dysfunction, length of stay in hospital and death, causing a massive burden of morbidity and mortality and increasing health care costs. If fresh blood is indeed better than standard issue blood, blood banks will be faced with the challenge of maintaining an adequate supply of fresh blood to meet the demands. In a single centre 910-patient pilot study funded by Canadian Institutes for Health Research ("INFORM-Pilot") we have shown that it is feasible to randomize the majority of hospitalized patients to receive fresh compared with old blood and we are now planning a very large, high efficiency and low-cost study ("INFORM"), involving more than 24,000 patients, to properly answer the question. If we find that fresh blood is safer than old blood, methods of blood storage and inventory management might have to be dramatically overhauled whereas a finding of no difference in safety of old blood compared with fresh blood will be reassuring for regulators, blood bankers and patients.