Introducing the red cell storage lesion

The storage of red blood cells under standard blood‐banking conditions leads to a decline in red cell quality and function known as the red cell storage lesion. These changes are linked to alterations in cellular biochemical processes, biomechanical effects and damage from oxidation. Although storage‐related alterations in red cells can be readily measured in the laboratory, the clinical impact of the storage lesion is not as easy to demonstrate. While some immediate differences between fresh and stored cells can be measured, red cells recover in the circulation to some degree upon transfusion with a concomitant reduction in the effect of the storage lesion. The clinical literature is inconsistent with studies arguing that long‐term stored red cells have a clinical impact and other studies including recent randomized controlled trials have failed to show any effect of the storage lesion on patient outcomes. Amelioration of the storage lesion will require further development of novel storage processes as well as an increased understanding of the role that donor‐specific factors play in product quality.