Fig. 2.

Donor-, time-, and processing-dependent RBC storage lesions. RBCs undergo various injuries during storage in their biochemical content, oxidative state, and morphology. Major biochemical changes include the depletion of ATP and 2,3-DPG. This is accompanied by an increase in reactive oxygen species damaging proteins and lipids (through increased malondialdehyde—MDA), among other injuries affecting the cellular integrity. These injuries are often observed as irreversible RBC morphological changes resulting in loss of integrity (hemolysis), deformability, and discoid morphology. While these alterations have a general time-dependent trend, they also depend on the donor and the initial blood processing, which varies among blood collection centers. These donor-, time-, and processing-dependent changes are not monitored in today’s practice of blood banking.