Abstract
The ability to store red blood cells (RBCs) and other components for extended periods of time has expanded the availability and use of transfusion as a life-saving therapy. However, conventional RBC storage has a limited window of effective preservation and is accompanied by the progressive accumulation of a series of biochemical and morphological modifications, collectively referred to as “storage lesions.” These lesions have been associated with negative clinical outcomes (i.e., postoperative complications as well as reduced short-term and long-term survival) in patients transfused with conventionally stored blood with older and deteriorated transfused red cells. Hence, there is an increased unmet need for improved RBC storage. Hypoxic storage of blood entails the removal of large amounts of oxygen to low levels prior to refrigeration and maintenance of hypoxic levels through the entirety of storage. As opposed to conventionally stored blood, hypoxic storage can lead to a reduction of oxidative damage to slow storage lesion development and create a storage condition expected to result in enhanced efficacy of stored RBCs without an effect on oxygen exchange in the lung. Hypoxic blood transfusions appear to offer minimal safety concerns, even in patients with hypoxemia. This review describes the physiology of hypoxically stored blood, how it differs from conventionally stored blood, and its use in potential clinical application, such as massively transfused and critically ill patients with oxygenation/ventilation impairments.
Highlights
Blood transfusions are the most common hospital procedures in the United States, with more than 11 million red blood cell (RBC) units transfused every year (Jones et al, 2019; D’Alessandro et al, 2020)
As soon as whole blood is collected from a donor, red blood cells begin to degrade, and transfusion of stored RBCs, those at the end of the approved shelf life, have been implicated in adverse clinical outcomes (Flegel et al, 2014)
Hypoxic Blood Infusion Pulmonary Physiology is accompanied by the progressive accumulation of a series of biochemical and morphological modifications, collectively referred to as the “storage lesion” (Yoshida et al, 2019)
Summary
Blood transfusions are the most common hospital procedures in the United States, with more than 11 million red blood cell (RBC) units transfused every year (Jones et al, 2019; D’Alessandro et al, 2020). We will discuss the theoretical implication of using hypoxically stored blood in patients with oxygenation/ventilation impairments.
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