WASHINGTON, D.C.—After a serious injury, the leading cause of death is loss of blood. Major trauma victims who receive transfusions of packed blood 22 days old or older face increased risk of death within 24 hours, according to a new study in Annals of Emergency Medicine.

“Our analysis shows that transfusions with blood older than 22 days are potentially toxic,” said Allison R. Jones, PhD, RN, Assistant Professor, Department of Acute, Chronic and Continuing Care, School of Nursing, University of Alabama at Birmingham and lead study author. “To avoid adverse events or death, patients who require massive transfusions should be given fresh stored packed blood products.”

Packed red blood cells aged 22 days or more were associated with a five percent increase in mortality risk, according to the study, “Older Blood Is Associated With Increased Mortality and Adverse Events in Massively Transfused Trauma Patients.” The secondary analysis of data from the Pragmatic, Randomized Optimal Plasma and Platelet Ration (PROPPR) trial looked at 678 patients in 12 Level I trauma centers nationwide.

As more units of packed red blood cells were transfused, the likelihood of harm increased, the study found. Major trauma victims require can require massive transfusions of blood or blood products in a very short time, making them more vulnerable to stored blood toxicity. Clinical effects of stored blood toxicity include elevated risk of clots, infection, organ failure and death.

“This study highlights a public health challenge that needs more attention — the nation’s health care providers are in the middle of a blood and plasma shortage. We all need to do a better job of encouraging qualified individuals to donate blood and blood products in order to avoid delays in lifesaving care,” said Dr. Jones.

More information about blood donation is available from the Red Cross here.