Abstract
The past two decades have witnessed increased scrutiny regarding efficacy and risk of the once unquestioned therapy of red blood cell (RBC) transfusion. Simultaneously, a variety of changes have been identified within the RBC and storage media during RBC preservation that are correlated with reduced tissue oxygenation and transfusion-associated adverse effects. These alterations are collectively termed the storage lesion and include extensive biochemical, biomechanical, and immunologic changes involving cells of diverse origin. Time-dependent falls is 2,3-diphosphoglycerate, intracellular RBC adenosine triphosphate, and nitric oxide have been shown to impact RBC deformability and delivery of oxygen to the end-organ. The accumulation of biologic response modifiers such as soluble CD40 ligand (sCD40L), lysophosphatidylcholine (lyso-PC), and Regulated on Activation, Normal T-cell Expressed and Secreted (RANTES) have been associated with altered recipient immune function as well. This review will address the alterations occurring within the RBC and storage media during RBC preservation and will address the potential clinical consequence thereof.
Highlights
Since the first successful attempt at blood storage almost a century ago, advances in extracorporeal red blood cell (RBC) preservation have incrementally prolonged the viability of stored RBCs
While adenosine triphosphate (ATP) depletion can result in the characteristic deformation changes seen with prolonged RBC storage, these morphologic changes are readably reversed with normalization of ATP levels ( )
The past two decades have witnessed an extensive re-evaluation of the risks and benefits of RBC transfusion
Summary
Since the first successful attempt at blood storage almost a century ago, advances in extracorporeal red blood cell (RBC) preservation have incrementally prolonged the viability of stored RBCs. Persistent difficulties evaluating the efficacy of RBC transfusion has resulted in the exclusive reliance on post-transfusion -hour RBC survival when defining the acceptable RBC storage duration. The various changes that occur within both the RBC and storage media during ex vivo preservation have been collectively termed the RBC “storage lesion” (Figure ). These alterations can be extensive and are primarily classified into three broad categories: biochemical, biomechanical, and immunologic.
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