Blood Components

Storage lesion

Biochemical and structural changes that occur in red blood cells during refrigerated storage at 1 to 6 degrees Celsius

Primary cause of storage lesion

Refrigerated storage slows metabolism but does not stop it leading to progressive metabolic depletion

Glucose during storage

Decreases over time as red cells continue glycolysis

ATP during storage

Decreases over time resulting in reduced membrane integrity and decreased cell survival

Effect of low ATP

eff- Red cell membrane becomes rigid leading to decreased deformability and increased hemolysis

2,3 DPG during storage

Decreases rapidly during storage

Effect of decreased 2,3 DPG

Hemoglobin affinity for oxygen increases causing reduced oxygen delivery to tissues

Oxygen dissociation curve change

Left shift occurs due to decreased 2,3 DPG

pH during storage

Decreases due to lactic acid accumulation

Cause of decreased pH

Anaerobic glycolysis produces lactic acid during storage

Sodium during storage

Decreases within stored red cells

Potassium during storage

Increases in plasma due to leakage from red cells

Clinical concern of high potassium

Risk of hyperkalemia especially in neonates and massive transfusion patients

Plasma hemoglobin during storage

Increases due to red cell hemolysis

Lactic acid during storage

Increases contributing to acidification of the unit

Membrane changes in storage lesion

Loss of membrane flexibility and formation of echinocytes

Morphologic changes in stored RBCs

Cells become less deformable and more fragile

Impact on red cell survival

Reduced post transfusion survival as storage time increases

Rejuvenation solution purpose

Restores ATP and 2,3 DPG levels before freezing rare units

Additive solution benefit

Extends shelf life by providing nutrients that support ATP production

Maximum shelf life with additive solution

Forty two days

Time course of 2,3 DPG depletion

Drops significantly within first two weeks of storage

Recovery of 2,3 DPG after transfusion

Typically replenished within twenty four to seventy two hours in the patient

Main metabolic pathway active in stored RBCs

Anaerobic glycolysis

Effect of storage lesion on oxygen delivery

Temporarily reduced until 2,3 DPG regenerates

Risk populations for storage lesion effects

Neonates critically ill patients and massive transfusion recipients

Biochemical pattern of storage lesion

Low ATP low 2,3 DPG low pH high potassium high lactic acid

Temperature of RBC storage

One to six degrees Celsius

Why storage lesion occurs

Red cells remain metabolically active during refrigeration but lack full physiologic support

Clinical significance overall

Most healthy adults tolerate storage lesion but vulnerable patients may be affected