The storage of red blood cells (RBCs) in a hypoxic environment was associated with the preservation of oxygen exchange properties, thereby improving the functional outcomes of RBCs in long-term storage compared with current standard protocols, according to a study published in Blood Advances.

Long-term storage of RBCs is known to result in biochemical and morphologic changes. Hypoxic storage of RBCs has been hypothesized to reduce oxidative damage. The aim of this study was to assess whether hypoxic storage preserves oxygen handling by RBCs compared with current standard storage conditions.

RBCs were harvested from fresh blood samples donated by healthy volunteers. The study evaluated the gas-handling properties of RBCs in hypoxic conditions using a microfluidic chamber and oxygen saturation imaging for up to 49 days. Metabolomics, lipidomics, redox proteomics, and oxygen unloading kinetics were also assessed.

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The hypoxic storage conditions were effective in reducing the oxygen saturation of the stored blood, with a mean of 54.4 on day 7 and 81.5 on day 49 compared with approximately 10 from day 7 to day 49 (P <.01 at all time points).

Oxygen unloading was improved in RBCs stored in a hypoxia for up to 35 days compared with RBCs stored using the current standard protocol. This improvement was similar to that observed with biochemical rejuvenation done at 4 weeks.

“In clinical practice, the median storage duration of transfused units is 21 days, and at this point, the beneficial effect of hypoxic storage was consistent in all 6 blood pools studied,” the authors wrote in their report.

Hypoxia resulted in limited changes in the expression or posttranslational modifications of proteins. There was an increase in SNCA expression, and increased oxidation of SLC4A1, PARK7, DDI2, PCMT1, SLC2A1, and PGK1. However, these changes were not associated with oxygen handling.

The authors concluded that “relative to standard blood-bank protocols, hypoxic storage preserves faster oxygen unloading from red cells through metabolic remodeling.”

Disclosures: Some of the study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of disclosures.


Rabcuka J, Blonski S, Meli A, et al. Metabolic reprogramming under hypoxic storage preserves faster oxygen unloading from stored red blood cells. Blood Adv. 2022;6:5415-5528. doi: 10.1182/bloodadvances.2022007774

This article originally appeared on Hematology Advisor