RBC units are transfused to critically ill patients to increase oxygen delivery and utilization to prevent organ failure and death. RBC units are stored up to 42 days in USA and Canada without any direct evidence of sustained efficacy for increased oxygen delivery and utilization. Presently, the standard policy for the majority of children in American and Canadian hospitals is to dispense the oldest RBC unit available in the blood bank 1, 2 to limit waste. The potential effect of this practice on outcomes in this population is unknown. Except for infectious risks, the safety of this policy has not been adequately examined in non-neonatal pediatric clinical trials.

In the US and Canada, the majority of critically ill children preferentially receive the oldest RBCs in inventory1. Conversely, there are few critically ill pediatric populations that preferentially only receive RBCs less than 7 days of storage1. There is no evidence that this practice improves outcomes either.

There is insufficient evidence to guide or alter current practice and equipoise remains for the question of whether RBC storage duration affects clinical outcomes. ABC PICU is designed to determine if the transfusion of RBCs stored for 7 days or less improves outcomes in critically ill children.

Additional Information about the trial can be found at ClinicalTrials.gov: http://clinicaltrials.gov/ct2/show/NCT01977547

1Spinella PC, Dressler A, Tucci M, Carroll CL, Rosen RS, Hume H, et al. Survey of transfusion policies at US and Canadian children's hospitals in 2008 and 2009. Transfusion. 2010;50(11):2328-35. doi: 10.1111/j.1537-2995.2010.02708.x. PubMed PMID: 20529008.

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