Table 1 Main components of the storage lesion.
Changes occurring to the RBC | Changes occurring in the supernatant |
|---|---|
Metabolic changes | |
• Decreased 2-3 DPG, possibly with impaired oxygen delivery [5] • Decreased phosphate and adenine pool (AMP, ADP, ATP) [24] • Decreased glutathione levels [6] • Decreased S-nitroso hemoglobin [110] • Increased lactate levels | • Decreased pH • Increased potassium concentrations (decreased Na-K-ATPase activity) with increased risks of hyperkalemia • Release of various molecules: ○ Proinflammatory cytokines (IL-1beta, IL-6, IL-8, TNF-alpha) and complement ○ Biologically active lipids such as platelet-activating factor (PAF) [14] ○ Free hemoglobin prone to scavenge nitric oxide (NO) of the recipient (together with Hb-containing microparticles) [109] ○ Heme and iron [12] with potential redox injuries, cytotoxicity and inflammation |
Oxidative stress | |
• Protein oxidation including cytoskeleton [111] • Lipid peroxidation, generation of lysophospholipids prone to cause cases of TRALI, generation of prostaglandins and isoprostanes [112] | |
Shape and membrane changes | |
• Shift from early reversible echinocytes to irreversible sphero-echinocytes • Generation of microvesicles with procoagulant properties • Increased RBC rigidity and adherence to vascular endothelium2 • Decreased CD47 expression, increased phosphatidylserine exposure |