Prolonged red cell storage before transfusion increases extravascular hemolysis.

Area of Science:

• Blood banking and transfusion medicine
• Hematology
• Immunology

Background:

• Current US regulations permit red blood cell storage for up to 6 weeks.
• Limited clinical data exist on the impact of the final storage week on patient outcomes.
• Some countries enforce a 5-week maximum storage limit for red cells.

Purpose of the Study:

• To evaluate the clinical effects of extended red blood cell storage, specifically the sixth week.
• To assess posttransfusion outcomes in healthy volunteers receiving autologous red cells stored for varying durations.

Main Methods:

• Sixty healthy volunteers received autologous leukoreduced packed red cells stored for 1 to 6 weeks (10 per group).
• Posttransfusion recovery studies using 51-Chromium were conducted.
• Laboratory parameters were monitored before and after transfusion.

Main Results:

• Increasing storage duration correlated with higher extravascular hemolysis and elevated serum iron levels.
• Posttransfusion red cell recovery and hematocrit elevations decreased with longer storage.
• Six weeks of storage led to increased serum iron, transferrin saturation, and nontransferrin-bound iron.

Conclusions:

• Transfusing red cells stored for 6 weeks increased hemolysis and iron-related biomarkers in healthy volunteers.
• These findings suggest potential risks associated with prolonged storage.
• A reduction in the maximum allowable red cell storage duration, potentially to 35 days, is recommended.