The Association between the Erythrocyte Storage Duration and Postoperative Pneumonia Risk in Children Undergoing Cardiac Surgery with Cardiopulmonary Bypass

doi:10.3969/j.issn.1671-2587.2026.02.007

JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE ›› 2026, Vol. 28 ›› Issue (2): 192-197.DOI: 10.3969/j.issn.1671-2587.2026.02.007

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The Association between the Erythrocyte Storage Duration and Postoperative Pneumonia Risk in Children Undergoing Cardiac Surgery with Cardiopulmonary Bypass

FU Xiaoyan, QIU Lijuan, ZHEN Zida, NIU Zijian, MA Shuxuan

Department of Blood Transfusion, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045

Received:2025-06-23 Accepted:2025-07-29 Online:2026-04-20 Published:2026-04-22

Abstract

Abstract: Objective To investigate the association between the longer red blood cell (RBC) storage duration and postoperative pneumonia (POP) in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods A retrospective analysis of 444 children with congenital heart disease who underwent CPB cardiac surgery at our hospital from January 2022 to July 2024 was performed, and they were divided into fresh RBC group (storage duration≤14 d, n=214) and the older RBC group (storage duration with 14~35 d, n=230). The incidence and pathogen distribution of POP were compared between two groups. Results Among 444 enrolled patients, 35 developed POP (7.89%). In the fresh RBC group, 11 of 214 patients (5.14%) developed POP, compared to 24 of 230 patients (10.43%) in the older RBC group. Statistical analysis revealed a significantly higher incidence of POP in patients receiving older RBC versus fresh RBC (χ²=4.242, P=0.039). Pathogen distribution in POP cases of the new RBC group was Gram-negative bacteria (n=6), Gram-positive bacteria (n=3) and others (n=2). Pathogen distribution in POP cases of the older RBC blood group was Gram-negative bacteria (n=13), Gram-positive bacteria (n=5) and others (n=6). There was no significant difference in pathogen spectrum between two groups (P=0.907). Conclusion Prolonged storage duration of priming RBCs may increase the risk of POP in children undergoing CPB cardiac surgery without altering the pathogenic bacterial spectrum.

Key words: Red blood cell storage duration, Cardiopulmonary bypass, Postoperative pneumonia, Pediatric cardiac surgery

CLC Number:

R726

FU Xiaoyan, QIU Lijuan, ZHEN Zida, NIU Zijian, MA Shuxuan. The Association between the Erythrocyte Storage Duration and Postoperative Pneumonia Risk in Children Undergoing Cardiac Surgery with Cardiopulmonary Bypass[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2026, 28(2): 192-197.

References

[1] Medikonda R,Ong C S,Wadia R,et al.Trends and updates on cardiopulmonary bypass setup in pediatric cardiac surgery[J]. J Cardiothorac Vasc Anesth,2019, 33(10):2804-2813.
[2] Cholette J M,Pietropaoli A P,Henrichs K F,et al.Longer RBC storage duration is associated with increased postoperative infections in pediatric cardiac surgery[J]. Pediatr Crit Care Med,2015,16(3):227-235.
[3] Redlin M,Habazettl H,Schoenfeld H,et al.Red blood cell storage duration is associated with various clinical outcomes in pediatric cardiac surgery[J]. Transfus Med Hemother,2014,41(2):146-151.
[4] Manlhiot C,Mccrindle B W,Menjak I B,et al.Longer blood storage is associated with suboptimal outcomes in high-risk pediatric cardiac surgery[J]. Ann Thorac Surg,2012,93(5):1563-1569.
[5] Tweddell S,Loomba R S,Cooper D S,et al.Health care-associated infections are associated with increased length of stay and cost but not mortality in children undergoing cardiac surgery[J]. Congenit Heart Dis,2019, 14(5):785-790.
[6] Li M,Nie Y J,Qiu G S,et al.Risk factors for early secondary infections after cardiopulmonary bypass in children with congenital heart disease: a single-center analysis of 265 cases[J]. Transl Pediatr,2025,14(1):104-112.
[7] Ailawadi G,Chang H L,O'Gara P T,et al. Pneumonia after cardiac surgery: experience of the national institutes of health/Canadian institutes of health research cardiothoracic surgical trials network[J]. J Thorac Cardiovasc Surg,2017,153(6):1384-1391.e3.
[8] Massart N,Mansour A,Ross J T,et al. Mortality due to hospital-acquired infection after cardiac surgery[J]. J Thorac Cardiovasc Surg,2022,163(6):2131-2140.e3.
[9] Donadee C,Raat N J H,Kanias T,et al. Nitric oxide scavenging by red blood cell microparticles and cell-free hemoglobin as a mechanism for the red cell storage lesion[J]. Circulation,2011,124(4):465-476.
[10] Fergusson D A,Hébert P,Hogan D L,et al.Effect of fresh red blood cell transfusions on clinical outcomes in premature,very low-birth-weight infants: the ARIPI randomized trial[J]. JAMA,2012,308(14):1443-1451.
[11] Long K,Meier C,Bernard A,et al.T-cell suppression by red blood cells is dependent on intact cells and is a consequence of blood bank processing[J]. Transfusion, 2014,54(5):1340-1347.
[12] 中华预防医学会医院感染控制分会第四届委员会重点部位感染防控学组. 术后肺炎预防和控制专家共识[J]. 中华临床感染病杂志,2018,11(1):11-19.
[13] Chen L F,Arduino J M,Sheng S B,et al.Epidemiology and outcome of major postoperative infections following cardiac surgery: risk factors and impact of pathogen type[J]. Am J Infect Control,2012,40(10):963-968.
[14] 王阔,范志伟,王东进. 心脏外科手术后肺炎的危险因素分析[J]. 中华解剖与临床杂志,2024,29(9):597-602.
[15] Koch C G,Li L,Sessler D I,et al.Duration of red-cell storage and complications after cardiac surgery[J]. N Engl J Med,2008,358(12):1229-1239.
[16] Sparrow R L.Red blood cell storage duration and trauma[J]. Transfus Med Rev,2015,29(2):120-126.
[17] Grimshaw K,Sahler J,Spinelli S L,et al.New frontiers in transfusion biology: identification and significance of mediators of morbidity and mortality in stored red blood cells[J]. Transfusion,2011,51(4):874-880.
[18] Straat M,Böing A N,Tuip-De Boer A,et al. Extracellular vesicles from red blood cell products induce a strong pro-inflammatory host response,dependent on both numbers and storage duration[J]. Transfus Med Hemother,2016,43(4):302-305.
[19] Sut C,Tariket S,Chou M L,et al.Duration of red blood cell storage and inflammatory marker generation[J]. Blood Transfus,2017,15(2):145-152.
[20] Rapido F,Brittenham G M,Bandyopadhyay S,et al.Prolonged red cell storage before transfusion increases extravascular hemolysis[J]. J Clin Invest,2017,127(1): 375-382.
[21] Lannan K L,Sahler J,Spinelli S L,et al.Transfusion immunomodulation—the case for leukoreduced and (perhaps) washed transfusions[J]. Blood Cells Mol Dis, 2013,50(1):61-68.
[22] Padiyath A,Lo B D,Ong C S,et al.Red blood cell storage duration and peri-operative outcomes in paediatric cardiac surgery[J]. Vox Sang,2021,116(9): 965-975.
[23] 冯子阳,黄韦华,唐河山,等. 红细胞储存损伤释放的游离血红素通过内质网应激诱导NETosis加重创伤-失血性休克小鼠模型炎症反应的作用机制研究[J]. 临床输血与检验,2025,27(5):585-593.
[24] Prestia K,Bandyopadhyay S,Slate A,et al.Transfusion of stored blood impairs host defenses against Gram-negative pathogens in mice[J]. Transfusion,2014,54(11):2842-2851.
[25] Solomon S B,Wang D,Sun J F,et al.Mortality increases after massive exchange transfusion with older stored blood in canines with experimental pneumonia[J]. Blood,2013,121(9):1663-1672.
[26] Steiner M E,Ness P M,Assmann S F,et al.Effects of red-cell storage duration on patients undergoing cardiac surgery[J]. N Engl J Med,2015,372(15):1419-1429.
[27] Lacroix J,Hébert P C,Fergusson D A,et al.Age of transfused blood in critically ill adults[J]. N Engl J Med,2015,372(15):1410-1418.
[28] Bishnoi A K,Garg P,Patel K,et al.Effect of red blood cell storage duration on outcome after paediatric cardiac surgery: a prospective observational study[J]. Heart Lung Circ,2019,28(5):784-791.
[29] Kawase H,Egi M,Kanazawa T,et al.Storage duration of transfused red blood cells is not significantly associated with postoperative adverse events in pediatric cardiac surgery patients[J]. Transfus Apher Sci,2016,54(1):111-116.
[30] Hod E A,Brittenham G M,Billote G B,et al.Transfusion of human volunteers with older,stored red blood cells produces extravascular hemolysis and circulating non-transferrin-bound iron[J]. Blood,2011,118(25):6675-6682.
[31] Galdino A C M,Vaillancourt M,Celedonio D,et al. Siderophores promote cooperative interspecies and intraspecies cross-protection against antibiotics in vitro[J]. Nat Microbiol,2024,9(3):631-646.

The Association between the Erythrocyte Storage Duration and Postoperative Pneumonia Risk in Children Undergoing Cardiac Surgery with Cardiopulmonary Bypass

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