Stored blood: how old is too old?

Transfusion of rbc is a routine, often lifesaving procedure that depends on a stored supply of blood. In the US, 42 days is the maximum duration allowed for rbc storage; however, several lines of evidence indicate that patients that receive blood at the upper end of this storage limit are at a higher risk of morbidity and mortality. In this issue of the JCI, Rapido and colleagues evaluated the effects of transfusing one unit of blood close to the storage limit into healthy adults. Compared to those that received rbc stored for five weeks or less, those that received blood stored for six weeks showed several effects associated with increased harm, including disruption in iron handling, increased extravascular hemolysis, and the formation of circulating non-transferrin-bound iron. Together, the results of this study suggest that current maximum storage durations should be carefully reevaluated.