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THE Science

Stored Blood

History of Blood Transfusions

Blood transfusions save millions of lives every day in the US and across the globe. First attempted in the 1600s, it was not until the 1800s that the first successful human transfusion was performed. Since then, improvements in blood typing, donor screening, pathogen testing, and processing and storage methods have significantly improved the clinical benefits of blood transfusion and reduced the risks.1 Blood transfusion services are an important part of the health-care system since blood transfusion is required in a number of frequently occurring clinical situations and red blood cells (RBCs) units2 are the most requested transfusion product worldwide.3

Blood Components & Therapy

Blood is made up of several components such as plasma, platelets, white blood cells and red blood cells.4 Typically, donated blood is separated into components and patients receive just the components of the blood needed to treat their particular condition. This approach to treatment, referred to as blood component therapy, allows several patients to benefit from one unit of donated whole blood.5

In some clinical situations, the use of whole blood may be preferred to component therapy, but stored components remain the method of transfusion therapy used in most hospitals.6

Red Blood Cells (RBCs)

Red blood cells (RBCs) are the most common type of cell found in the blood and give blood its red color.5 A unit of Leukocyte-Reduced RBC is prepared from whole blood by separating out the plasma and platelets and having the white blood cells (leukocytes) filtered out after donation.4 RBCs contain hemoglobin, a complex protein containing iron that carries oxygen through the body.5 Generated in the bone marrow, RBCs are continuously produced and broken down in a healthy circulatory system.4

RBC Storage – Not All Blood is the Same

The ability to store RBCs and other components for extended periods of time has dramatically expanded the availability and use of transfusion as a life-saving therapy.3 However, as soon as whole blood is collected from a donor, red blood cells begin to degrade. RBCs experience progressive biochemical and biomechanical changes during storage, collectively called the “storage lesion”, that result in compromised physiological functions. This can reduce the ability of RBCs to remain in the body and may affect their ability to deliver oxygen within a patient after transfusion.8-12

See a depiction of the degradation process that occurs during blood storage and how it impacts two of the major functions of RBCs in this 3D animation below.

Learn more about what happens to red blood cells during storage

Function of RBCs

Two of the major functions of RBCs are to:
  1. Carry oxygen from the lungs to the tissue around the body; and
  2. Transport carbon dioxide from tissue to the lungs where it can be exhaled.7

References:

1. American Red Cross. History of Blood Transfusion. . Accessed October 3, 2022. https://www.redcrossblood.org/donate-blood/blood-donation-process/what-happens-to-donated-blood/blood-transfusions/history-blood-transfusion.html. 2. Jersild, C., & Hafner, V. (2008); Blood Transfusion Services. International Encyclopedia of Public Health, 325–329. https://doi.org/10.1016/B978-012373960-5.00520-7. 3. García-Roa M, Del Carmen Vicente-Ayuso M, Bobes AM, et al. Red blood cell storage time and transfusion: current practice, concerns and future perspectives. Blood Transfus. 2017;15(3):222-231. doi:10.2450/2017.0345-16. 4. Blood Components. The American National Red Cross. Updated 2022. Accessed October 3rd, 2022. https://www.redcrossblood.org/donate-blood/how-to-donate/types-of-blood-donations/blood-components.html. 5. Dean L. Chapter 1: Blood and the cells it contains. Belinda Beck, eds. In: Dean L, ed. Blood Groups and Red Cell Antigens. Bethesda (MD): National Center for Biotechnology Information (US); 2005. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2263/. 6. Gurevitz S. Update and utilization of component therapy in blood transfusions. Laboratory Medicine. 2010;41(12):739-744. 7. John F. Daily, Dailey’s Notes on Blood, Fourth Edition. (pages 26-35). 8. Yoshida T, Blair A, D’Alessandro A, et al. Enhancing uniformity and overall quality of red cell concentrate with anaerobic storage. Blood Transfus 2017;15:172-81. 9. Orlov D, Karkouti K. The pathophysiology and consequences of red blood cell storage. Anaesthesia. 2015;70 Suppl 1:29-37, e9-12. (Review article). 10. Hess JR. Measures of stored red blood cell quality. Vox Sanguinis 2014; 107:1-9. (Review article). 11. Zimring JC. Established and theoretical factors to consider in assessing the red cell storage lesion. Blood. 2015; 125:2185-90. (Review article). 12. Yoshida T et al. Red blood cell storage lesion: causes and potential clinical consequences. Blood Transfus. 2019; 17: 27-52. (Review article).

 

Stored Blood

Storage Lesion

Clinical Implications

Hypoxic Storage