Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 60 11 2023 01 10 680 687 Nastaran Rahimi Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Behnam Behnoush Department of Forensic Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. AND Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran Hamed Hosseini Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran. Amir A Fakhrabadi Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. Nina Javadian Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. Nasrin Barzegari arzegari Dahaj Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran Adeleh Maleki Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Morteza Tabatabaei Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran Ahmad Reza Dehpour Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2022 09 14 2022 11 09 Accidental or intentional poisoning with Aluminum phosphide (AlP) is associated with severe complications such as metabolic acidosis, cardiac failure, and death. Previous animal experiments demonstrated that fresh-packed RBC is protective in an experimental model of AlP poisoning. The aim of this study was to assess the effect of fresh-packed RBC on survival in patients admitted to a referral hospital due to AlP poisoning in a randomized clinical trial. Eighty-two patients were admitted to Clinical Toxicology Unit at Baharloo Hospital due to acute AlP poisoning after approval by the Iranian Registry of Clinical Trials (registration reference: IRCT20180428039443N1). All patients received standard treatment, and forty-one of them received fresh-packed RBC. There was no significant difference between groups in the underlying characteristics, including vital signs and laboratory investigations. But interestingly, the mortality rate was meaningfully decreased (difference: 31.7%, 95% CI: 0.10-0.52) in patients receiving fresh-packed RBC (10 deaths/31 survived; 24.4% mortality) in comparison to standard treatment patients (23 deaths/18 survived; 56.1% mortality). Furthermore, fresh-packed RBC substantially improved the GCS, systolic/diastolic blood pressure, ST changes, and pH 12- and- 24 hours after admission. This study showed that fresh-packed RBC infusion alongside standard supportive treatment leads to a decrease in mortality rate; also, it provided evidence for a protective role of fresh-packed RBC in the management of patients with acute AlP poisoning. https://acta.tums.ac.ir/index.php/acta/article/view/10359