storage lesion

 Q; Prolonged storage of packed red blood cell may cause all of the following EXCEPT? (select one) 

A) increased pH 

B) chelation of calcium 

C) low 2,3-diphosphoglycerate (DPG) levels 

D) decreased clotting factor concentration

Answer: A

It has been suggested that one of the reasons for resuscitation associated coagulopathy is the prolonged storage of packed red blood cell (pRBC) in blood bank. The term "storage lesion" has been coined for this phenomenon. The components of storage lesion includes decreased pH, chelation of calcium, low 2,3-DPG levels, and decreased clotting factor concentration. 

Studies have shown that despite these changes there is no difference in outcome between fresh pRBCs and stored pRBCs transfusions. 

The objective of this pearl is to discourage clinicians from writing orders for "only fresh pRBC units". This can have high undesirable challenges on blood supplies.

#hematology

References:

1. Green RS, Erdogan M, Lacroix J, et al. Age of transfused blood in critically ill adult trauma patients: a prespecified nested analysis of the Age of Blood Evaluation randomized trial. Transfusion 2018; 58:1846. 

2.  Steiner ME, Ness PM, Assmann SF, et al. Effects of red-cell storage duration on patients undergoing cardiac surgery. N Engl J Med 2015; 372:1419. 

3. Heddle NM, Cook RJ, Arnold DM, et al. Effect of Short-Term vs. Long-Term Blood Storage on Mortality after Transfusion. N Engl J Med 2016; 375:1937. 

4. Lacroix J, Hébert PC, Fergusson DA, et al. Age of transfused blood in critically ill adults. N Engl J Med 2015; 372:1410.