title: Effects of storage on efficacy of red cell transfusion: when is it not safe?
abstract: OBJECTIVE
  To review the literature on red blood cell storage and its relationship to the efficacy of transfusion.
  
  
  RESULTS
  Well-documented changes occur to the red blood cell product during ex vivo storage. These changes include a reduction in red blood cell deformability, altered red blood cell adhesiveness and aggregability, and a reduction in 2,3-diphosphoglycerate and ATP. Bioactive compounds with proinflammatory effects also accumulate in the storage medium. These changes reduce posttransfusion viability of red blood cells. The clinical effects beyond posttransfusion viability are uncertain, but a growing body of evidence suggests that the storage lesion may reduce tissue oxygen availability, have proinflammatory and immunomodulatory effects, and influence morbidity and mortality. There are no published randomized, control trials examining the effect of storage duration on morbidity and mortality. Leukoreduction improves the quality of stored red blood cell products and in some studies has been shown to reduce morbidity and mortality.
  
  
  CONCLUSIONS
  Although storage duration influences the quality of red blood cell product, there is currently insufficient evidence to advocate shorter storage periods for red blood cell products.
authors.affiliation: Departmentof Medicine, The University of Western Ontario, London, Canada.
authors.forename: Juliet
authors.initials: J
authors.lastname: Ho
authors.forename: William J
authors.initials: WJ
authors.lastname: Sibbald
authors.forename: Ian H
authors.initials: IH
authors.lastname: Chin-Yee
mesh_terms: D000740:Anemia / Q000097:blood / Q000401:mortality / Q000628:therapy; D000818:Animals; D001793:Blood Preservation / Q000009:adverse effects*; D003422:Critical Care / Q000379:methods*; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004912:Erythrocytes / Q000473:pathology*; D006801:Humans; D007902:Length of Stay; D023421:Models, Animal; D009017:Morbidity; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000209:etiology; D010043:Outcome and Process Assessment, Health Care; D051381:Rats; D018570:Risk Assessment