The Pathophysiology and Clinical Significance of Red Blood Cell Storage Lesions: A Literature Review Focused on Patient-Specific Outcomes

Red blood cell (RBC) transfusion is a critical component of medical care across diverse clinical scenarios, including surgery, critical illness, and hematologic disorders.During storage, RBCs experience a range of biochemical and structural alterations collectively known as red blood cell storage lesions (RSL), which include adenosine triphosphate (ATP) depletion, oxidative stress, membrane remodeling, and extracellular vesicle release.While these changes do not appear to significantly affect clinical outcomes in most transfused patients, evidence suggests that stored blood may be less effective in high-risk populations, such as critically ill or pediatric patients.This review summarizes the pathophysiological mechanisms of RSL and assesses their potential clinical implications, providing an integrated overview of current findings on RBC storage and transfusion outcomes.(