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Bastu Odoka: Storage Lesions – What Really Happens to Stored Blood

Bastu Odoka/LinkedIn

Apr 7, 2026, 13:32

Bastu Odoka: Storage Lesions – What Really Happens to Stored Blood

Bastu Odoka, Transfusion Scientist at Effia-Nkwanta Regional Hospital, shared a post on LinkedIn:

“Storage lesions: what really happens to stored blood

We often focus on compatibility before transfusion.

But there’s another layer we don’t talk about enough, how blood changes during storage.

Over time, stored red cells undergo what we call storage lesions.

Most of the time, this doesn’t change clinical decisions.

But in certain patients, it’s worth paying attention.

1. Potassium leakage

As red cells sit in storage, potassium gradually leaks into the plasma.

This becomes relevant in:

Neonates
Patients at risk of arrhythmias
Rapid or large-volume transfusion

Because high potassium can affect cardiac rhythm.

2. Loss of 2,3-DPG

Stored blood loses 2,3-DPG, which helps haemoglobin release oxygen.

So early after transfusion:

Haemoglobin holds oxygen more tightly
Tissue oxygen delivery may be reduced

This matters most in patients who need immediate oxygen delivery.

Good thing: levels recover within 24–72 hours after transfusion.

3. Microaggregate formation

With time, white cells, platelets, and cellular debris aggregate together.

This adds to the particulate load in blood and has been linked to concerns about microvascular flow, may cause pulmonary microvascular occlusion

This is one reason why:

Leukoreduction
Standard blood filters

are important in routine practice.

4. Reduced red cell flexibility

Stored red cells become less deformable.

Meaning: They don’t pass through tiny capillaries as easily, which can affect microcirculation in vulnerable patients (critically ill, neonates, and those with already compromised perfusion.)

5. Hemolysis and free haemoglobin

Some red cells break down during storage, releasing free haemoglobin.

This can:

Bind nitric oxide, causing vasoconstriction
Contribute to oxidative stress

In certain settings, it may also play a role in kidney injury.

6. Lactate accumulation and pH changes.

Red cells continue to metabolise during storage.

Result:

Lactate builds up
pH falls

In most patients, this is well tolerated.

But in large-volume transfusion, especially in:

Critically ill patients
Neonates

it can contribute to acid–base imbalance.

So what does this mean in practice?

For the majority of patients, standard-issue blood is safe and appropriate.

These changes are not a reason to avoid transfusion or reject older blood.

But in specific situations, critically ill patients, neonates, massive transfusion, being aware of storage-related changes can help guide safer decisions.

Blood saves lives.

But understanding how it changes helps us use it more thoughtfully.”

Bastu Odoka: Storage Lesions - What Really Happens to Stored Blood