Published online Nov 6, 2015. doi: 10.5315/wjh.v4.i4.54
Peer-review started: July 9, 2015
First decision: August 25, 2015
Revised: September 15, 2015
Accepted: October 16, 2015
Article in press: October 19, 2015
Published online: November 6, 2015
Red blood cell concentrates (RBCCs) are the major labile blood component transfused worldwide to rescue severe anemia symptoms. RBCCs are frequently stored in additive solutions at 4 °C for up to 42 d, which induces cellular lesion and alters red blood cell metabolism, protein content, and rheological properties. There exists a hot debate surrounding the impact of storage lesion, with some uncertainty regarding how RBCC age may impact transfusion-related adverse clinical outcomes. Several studies show a tendency for poorer outcomes to occur in patients receiving older blood products; however, no clear significant association has yet been demonstrated. Some age-related RBCC alterations prove reversible, while other changes are irreversible following protein oxidation. It is likely that any irreversible damage affects the blood component quality and thus the transfusion efficiency. The present paper aims to promote a better understanding of the occurrence of red blood cell storage lesion, with particular focus on biochemical changes and microvesiculation, through a discussion of the historical advancement of blood transfusion processes.
Core tip: This review paper puts in perspective the red blood cell storage lesion, which is a hot topic in transfusion medicine. Many different physiological and biochemical pathways are affected by cold storage, and stored red blood cells are clearly very different when compared to freshly drown erythrocytes. However, most of clinicians are lost in translation because experimental data and clinical data are divergent. Therefore, both fundamental, translational and clinical studies are needed in the near future to provide better care to our patients.