Red blood cells are solely responsible for supplying oxygen for mitochondrial metabolism in all the tissues of the body. This critical role has led to the ubiquitous use of red blood cells as a foundation for modern healthcare systems resulting in over 100 million units of blood prescribed globally to improve the oxygen carrying capacity of patients in need. In the body the red cell is uniquely equipped to juggle oxygen and the iron(II) atom in hemoglobin. However, upon storage, physiology is replaced by chemistry. In the presence of an uncontrolled abundance of oxygen the iron(II) is oxidized to iron(III) initiating a cascade of changes during storage that are attributed to oxidative damage which is dependent on the ability of the cell to protect itself from such oxidative damage. Degradation during storage reduces the ability of red blood cells to carry and to deliver oxygen and creates non-red cell by-products that are associated with adverse effects, and do not deliver oxygen; these by-products are transfused along with the red cells. A salient example is the unintended dose of free iron made available to patients under some transfusion conditions that is associated with adverse outcomes such as iron overload and infections.
Restate the role oxidative damage plays and the drivers that contribute to changes in red cell physiology during refrigerated storage.
Recognize the changes in red cell quality caused by oxidative damage as measured by current techniques.
Question the effects of oxidative damage and the role it plays on red cell quality, specifically in assessing successful patient treatment and expected outcomes
Identify donor- and process-related red cell characteristics which could mitigate oxidative damage and potential risk to patients.
Hypothesize potential opportunities, both short and long term, to improve red cell quality and resulting patient outcomes.