Current issues relating to the transfusion of stored red blood cells

Abstract

The development of blood storage systems allowed donation and transfusion to be separated in time and space. This separation has permitted the regionalization of donor services with subsequent economies of scale and improvements in the quality and availability of blood products. However, the availability of storage raises the question of how long blood products can and should be stored and how long they are safe and effective. The efficacy of red blood cells was originally measured as the increment in haematocrit and safety began with typing and the effort to reduce the risk of bacterial contamination. Appreciation of a growing list of storage lesions of red blood cells has developed with our increasing understanding of red blood cell physiology and our experience with red blood cell transfusion. However, other than frank haemolysis, rare episodes of bacterial contamination and overgrowth, the reduction of oxygen-carrying capacity associated with the failure of some transfused cells to circulate, and the toxicity of lysophospholipids released from membrane breakdown, storage-induced lesions have not had obvious correlations with safety or efficacy. The safety of red blood cell storage has also been approached in retrospective epidemiologic studies of transfused patients, but the results are frequently biased by the fact that sicker patients are transfused more often and blood banks do not issue blood products in a random order. Several large prospective studies of the safety of stored red blood cells are planned.

The Age of BLood Evaluation (ABLE) randomised controlled trial: description of the UK-funded arm of the international trial, the UK cost–utility analysis and secondary analyses exploring factors associated with health-related quality of life and health-care costs during the 12-month follow-up

“…6,8,16 During storage, RBCs undergo a predictable change in structure, evolving from biconcave discs to spheroechinocytes. These changes are associated with a number of biochemical and biomechanical changes, including a depletion of adenosine triphosphate and 2,3-diphosphoglycerate (2,3-DPG), membrane phospholipid vesiculation and loss, protein oxidation, lipid peroxidation of cell membranes and loss of deformability.…”

Fresh Whole Blood Transfusion: Military and Civilian Implications

“…9,10 Additionally, guidelines from the Food and Drug Administration regarding blood storage are based on red blood cell (RBC) membrane integrity and adenosine triphosphate levels within the cell and not on oxygen delivery to the tissues. 11 These concerns regarding the safety and effectiveness of transfusing older blood products as well as the lack of clinical outcomes to demonstrate the superiority or even equivalence of BCT to whole blood has resulted in a renewed interest in FWB therapy.…”

Time-course investigation of SAGM-stored leukocyte-filtered red bood cell concentrates: from metabolism to proteomics

“…Biochemical approaches have already provided convincing evidence that refrigerated storage causes alterations to RBC, which are only reversible to some extent; these alterations are an array of phenomena which are collectively called the "storage lesion". [8][9][10] Numerous changes occur in RBC during storage which may irreversibly alter their biological functions, including delivery of oxygen to cells. 11 Increases in O2 affinity in stored RBC have been well documented; 11,12 these reflect progressive decreases in 2,3-diphosphoglycerate (2,3-DPG) levels over the weeks of storage.…”

“…These lesions result in more rigid cells and reduced oxygen offloading. [8][9][10] The suspending fluid becomes enriched with free hemoglobin and biologically active lipids, along with large quantities of negatively charged microvesicles. 14,15 Membrane protein fragmentation 16 and accumulation of membrane biomarkers 17,18 have also been reported to correlate with storage duration.…”