Refers to changes in quality and quantity of packed red blood cells (pRBCs) during storage, including:
- Change in cell shape change and microvesiculation
- Decrease in adenosine triphosphate (ATP) and 2,3-diphosphoglycerate levels
- Increase in lysophospholipids
- Increase in potassium
- Increase in free hemoglobin (Hb)
The storage lesion represents a risk to efficient RBC perfusion and tissue oxygen delivery, and it has been suggested that it may result in adverse outcomes. This has led to the classification of “young” (21 days) RBC units. According to the AABB, 13 randomized control trials have evaluated the effect of RBC storage duration of transfused RBCs on patient outcomes (7 since 2012). However, there is currently no formal guidance on the optimal length of RBC storage prior to transfusion. The AABB recommends administering RBC units within licensed expiration date (standard issue) rather than transfusing only fresh RBCs (< 10 days old) to patients, including neonates.