Fresh or stored blood in critically ill children

Does it matter if you use fresh blood cells (less than 7 days old) compared with the standard stored red blood cells in critically ill children with multi organ failure? Over the years Lucina has heard this debate on neonatal and paediatric intensive care units (PICU) with many an argument unresolved. About 10%–20% of children end up with transfusions during their time on PICU. There has never been and randomised controlled study on PICUs, so it is interesting to see that Spinella PC et al [JAMA 2019; 322(22): 2179–2190. doi: 10.1001/jama.2019.17478] have reported the finding of the Age of Blood in Children (ABC-PICU) study which is a huge collaboration of networks including the Canadian Critical Care Trials Group. The study recruited from 50 centres (29 in the United States, 10 in Canada, 8 in France, 2 in Italy, and one in Israel). Children between the ages of 3 days and 16 years were eligible if the first red blood cell transfusion was administered within 7 days of intensive care unit admission. A total of 1538 patients were randomised with 768 patients in the fresh red blood cell group and 770 in the standard-issue group. There were …