Cumulative erythrocyte damage in blood storage and relevance to massive transfusions: selective insights into serial morphological and biochemical findings

Abstract

Elucidating the precise mechanisms of cumulative red cell damages during storage and the potential harmful consequences after transfusion are achievable by exacting laboratory science and well-defined clinical studies in progress. Accordingly, for larger magnitude blood transfusions (i.e. 8-12 U in 24 hours), the quality of the stored blood and its characterisation are of special academic and clinical importance. Our main objectives in this review are to illuminate facets of the red cell storage lesion for prolonged storage (0-42 days) by concentrating on various hallmarks of the disorder: 1) identifying and characterising serial markers of the progressive lesion with respect to red cell dysmorphology, deformability, haemolytic fragility and dysfunction both in storage and the microcirculation; and 2) relevant biochemical findings of redox status correlated to oxidative stress of erythrocyte proteins. This is accomplished in part by reliance on advanced metabolomic and proteomic technologies using various sophisticated tools such as high pressure liquid chromatography in combination with mass spectrometry of proteins and small molecule metabolites. It is anticipated that these sophisticated methodologies and the experimental results therein shall lead to further advances in the quality improvement of red cell storage.

Figure 1

The general Bessis morphology classification of red cell shapes. Reprinted with permission from Springer International^©3.

Figure 2

Scanning electron micrographs of discocyte transformation into echinocyte. (A) Discocyte. (B) Echinocyte II. (C) Echinocyte III. Reprinted with permission from Springer International^©.