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Drs. Janet Lee and Darrell Triulzi each present from the 2016 UPMC Department of Medicine Grand Rounds. Dr. Lee provides a brief introduction on red cell “storage lesion” and surrounding controversy, discusses aged RBC transfusion and the disruption in iron handling and homeostasis, and the disruptions in nitric oxide availability. Dr. Triulzi discusses the red cell storage criteria and reviews some clinical data trials. 

Educational objectives:

Upon completion of this activity, participants should be able to: 

  • Increase understanding of normal iron homeostasis in humans
  • Improve diagnostic skills in identifying intra- and extravascular hemolysis
  • Implement evidence-based RBC transfusion guidelines

Reading Resources:

  1. Carson, J. L., Guyatt, G., Heddle, N. M., Grossman, B. J., Cohn, C. S., Fung, M. K., Gernsheimer, T., Holcomb, J. B., Kaplan, L. J., Katz, L. M., Peterson, N., Ramsey, G., Rao, S. V., Roback, J. D., Shander, A. & Tobian, A. A. Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage. JAMA 316, 2025-2035, doi:10.1001/jama.2016.9185 (2016).
  2. Andrews, N. C. Disorders of iron metabolism. N Engl J Med 341, 1986-1995, doi:10.1056/NEJM199912233412607 (1999).
  3. Hod, E. A., Brittenham, G. M., Billote, G. B., Francis, R. O., Ginzburg, Y. Z., Hendrickson, J. E., Jhang, J., Schwartz, J., Sharma, S., Sheth, S., Sireci, A. N., Stephens, H. L., Stotler, B. A., Wojczyk, B. S., Zimring, J. C. & Spitalnik, S. L. Transfusion of human volunteers with older, stored red blood cells produces extravascular hemolysis and circulating non-transferrin-bound iron. Blood 118, 6675-6682, doi:10.1182/blood-2011-08-371849 (2011).
  4. Risbano, M. G., Kanias, T., Triulzi, D., Donadee, C., Barge, S., Badlam, J., Jain, S., Belanger, A. M., Kim-Shapiro, D. B. & Gladwin, M. T. Effects of Aged Stored Autologous Red Blood Cells on Human Endothelial Function. Am J Respir Crit Care Med 192, 1223-1233, doi:10.1164/rccm.201501-0145OC (2015).
  5. Heddle NM etal. Effect of long term vs short term blood storage on mortality after transfusion. NEJM online Oct 24, 2016. 6.Carson et al . Red Blood Cell Transfusion:2016 Clinical Practice Guidelines from the AABB. JAMA online Oct 12, 2106


Dr. Lee has financial interests with the following entity or entities producing health care goods or services as indicated below:

  • Grant/Research Support: NIH

Dr. Triulzi has financial interests with the following any entity or entities producing health care goods or services as indicated below:

  • Grant/Reasearch Support: Cerus Corp
  • Consultant: Fresenius-Kabi

All presenters disclosure of relevant financial relationships with any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients is listed above.  No other planners, members of the planning committee, speakers, presenters, authors, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships to disclose.

Accreditation Statement:

The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Pittsburgh School of Medicine designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Each physician should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded (0.1) continuing education units (CEU) which are equivalent to 1 contact hour.

For your credit transcript, please access our website 4 weeks post-completion at and follow the link to the Credit Transcript page. If you do not provide the last 5 digits of your SSN on the next page you will not be able to access a CME credit transcript. Providing your SSN is voluntary.

ABIM MOC Part 2 Credit

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. 

To receive your ABIM MOC Part 2 credit, you will need to complete the post-test with a pass rate of 100% and provide your date of birth and ABIM number, along with the other required fields.  This information will be shared with the American Board of Internal Medicine using the Accreditation Council for Continuing Medical Education Program and Activity Reporting System.


Release Date: 3/13/2017 | Last Modified On: 3/31/2020 | Expires: 2/10/2021

This course has been expired.