Red blood cell "freshness" dilemma: storage lesions

Storage lesions of red blood cell (RBC) refer to a series of physiological, biochemical, and morphological alterations that occur during extracellular preservation, leading to diminished functional capacity and reduced cellular lifespan. This paper reviews the primary pathological mechanisms of RBC storage lesion, including morphological alterations, energy metabolism disorders (decreases in ATP and 2,3-G levels), acidosis, ion pump dysfunction (K⁺ loss and Na⁺ accumulation), oxidative lesion (lipid peroxidation and structural changes of band 3 protein), and degradation of membrane phospholipids. An in-depth understanding of these mechanisms can help optimize RBC storage strategies and improve the safety and effectiveness of blood transfusions.