New frontiers in transfusion biology: identification and significance of mediators of morbidity and mortality in stored red blood cells

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Red blood cell (RBC) transfusions are associated with inflammation and thrombosis, both arterial and venous, the mechanisms of which are not understood. Although a necessary life-saving procedure in modern medicine, transfusions have rarely been subjected to modern assessments of efficacy and safety, including randomized trials. Storage of RBCs induces changes, including the release of free hemoglobin and the accumulation of biologically active soluble mediators and microparticles. These mediators likely play a direct role in the inflammatory and prothrombotic properties of RBC transfusions. Methods such as leukoreduction, washing of RBCs, and rejuvenation may improve the quality of RBC transfusions.