Addressing the question of the effect of RBC storage on clinical outcomes: The Red Cell Storage Duration Study (RECESS) (Section 7)

Marie E Steiner, S. F. Assmann, J. H. Levy, J. Marshall, S. Pulkrabek, S. R. Sloan, D. Triulzi, C. P. Stowell

Research output: Contribution to journalArticlepeer-review

107 Scopus citations


The question of whether storage of red blood cells (RBCs) alters their capacity to deliver oxygen and affects patient outcomes remains in a state of clinical equipoise. Studies of the changes which occur while RBCs are stored have led to several physiologically plausible hypotheses that these changes impair RBC function when the units are transfused. Although there is some evidence of this effect in vivo from animal model experiments, the results of several largely retrospective patient studies have not been consistent. Some studies have shown an association between worse clinical outcomes and transfusion of RBC which have been stored for longer periods of time, while others have found no effect. Three multicenter, randomized, controlled trials have been developed to address this important, but currently unanswered, question. Two clinical trials, one in low birth weight neonates and the other in intensive care unit patients, are enrolling subjects in Canada (the Age of Red Blood Cells in Premature Infants; the Age of Blood Study). The third trial, which is being developed in the United States, is the Red Cell Storage Duration Study (RECESS). This is a multicenter, randomized, controlled trial in which patients undergoing complex cardiac surgical procedures who are likely to require RBC transfusion will be randomized to receive RBC units stored for either 10 or fewer days or 21 or more days. Randomization will only occur if the blood bank has enough units of RBC of both storage times to meet the crossmatch request; hence, subjects randomized to the {greater-than above slanted equal above less-than above slanted equal}21. day arm will receive RBC of the same storage time as they would have following standard inventory practice of " oldest units out first" The primary outcome is the change in the Multiple Organ Dysfunction Score (MODS), a composite measure of multiorgan dysfunction, by day 7. Secondary outcomes include the change in the MODS by day 28, all-cause mortality, and several composite and single measures of specific organ system function. The estimated total sample size required will be 1434 evaluable subjects (717 per arm). The RECESS trial is registered through the US National Institutes of Health ( as NCT00991341.

Original languageEnglish (US)
Pages (from-to)107-116
Number of pages10
JournalTransfusion and Apheresis Science
Issue number1
StatePublished - Aug 2010

Bibliographical note

Funding Information:
RECESS was developed through, and will be conducted mainly within, the TMHCTN which is a multicenter clinical trials network including 17 main core clinical centers across the United States, and several affiliated sites. TMHCTN was originally funded by the National Heart, Lung and Blood Institute (Transfusion Medicine and Cellular Therapeutics Branch) of the National Institutes of Health in 2002 and renewed in 2007 [12] .


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