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Clinical Research and Public HealthIn-Press PreviewClinical ResearchHematology
Open Access | 10.1172/JCI192920
1Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, United States of America
2Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, United States of America
3Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, United States of America
4Division of Hematology and Blood Research Center, University of North Carolina, Chapel Hill, United States of America
5Department of Ophthalmology, Duke University School of Medicine, Durham, United States of America
6Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, United States of America
7Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, United States of America
8Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States of America
Find articles by Karafin, M. in: PubMed | Google Scholar
1Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, United States of America
2Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, United States of America
3Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, United States of America
4Division of Hematology and Blood Research Center, University of North Carolina, Chapel Hill, United States of America
5Department of Ophthalmology, Duke University School of Medicine, Durham, United States of America
6Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, United States of America
7Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, United States of America
8Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States of America
Find articles by Grier, A. in: PubMed | Google Scholar
1Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, United States of America
2Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, United States of America
3Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, United States of America
4Division of Hematology and Blood Research Center, University of North Carolina, Chapel Hill, United States of America
5Department of Ophthalmology, Duke University School of Medicine, Durham, United States of America
6Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, United States of America
7Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, United States of America
8Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States of America
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1Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, United States of America
2Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, United States of America
3Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, United States of America
4Division of Hematology and Blood Research Center, University of North Carolina, Chapel Hill, United States of America
5Department of Ophthalmology, Duke University School of Medicine, Durham, United States of America
6Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, United States of America
7Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, United States of America
8Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States of America
Find articles by Ilich, A. in: PubMed | Google Scholar
1Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, United States of America
2Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, United States of America
3Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, United States of America
4Division of Hematology and Blood Research Center, University of North Carolina, Chapel Hill, United States of America
5Department of Ophthalmology, Duke University School of Medicine, Durham, United States of America
6Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, United States of America
7Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, United States of America
8Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States of America
Find articles by Wichlan, D. in: PubMed | Google Scholar
1Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, United States of America
2Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, United States of America
3Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, United States of America
4Division of Hematology and Blood Research Center, University of North Carolina, Chapel Hill, United States of America
5Department of Ophthalmology, Duke University School of Medicine, Durham, United States of America
6Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, United States of America
7Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, United States of America
8Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States of America
Find articles by Chang, A. in: PubMed | Google Scholar
1Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, United States of America
2Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, United States of America
3Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, United States of America
4Division of Hematology and Blood Research Center, University of North Carolina, Chapel Hill, United States of America
5Department of Ophthalmology, Duke University School of Medicine, Durham, United States of America
6Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, United States of America
7Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, United States of America
8Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States of America
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1Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, United States of America
2Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, United States of America
3Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, United States of America
4Division of Hematology and Blood Research Center, University of North Carolina, Chapel Hill, United States of America
5Department of Ophthalmology, Duke University School of Medicine, Durham, United States of America
6Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, United States of America
7Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, United States of America
8Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States of America
Find articles by Butler, H. in: PubMed | Google Scholar
1Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, United States of America
2Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, United States of America
3Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, United States of America
4Division of Hematology and Blood Research Center, University of North Carolina, Chapel Hill, United States of America
5Department of Ophthalmology, Duke University School of Medicine, Durham, United States of America
6Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, United States of America
7Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, United States of America
8Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States of America
Find articles by Kolupaev, O. in: PubMed | Google Scholar
1Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, United States of America
2Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, United States of America
3Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, United States of America
4Division of Hematology and Blood Research Center, University of North Carolina, Chapel Hill, United States of America
5Department of Ophthalmology, Duke University School of Medicine, Durham, United States of America
6Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, United States of America
7Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, United States of America
8Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States of America
Find articles by Caughey, M. in: PubMed | Google Scholar
1Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, United States of America
2Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, United States of America
3Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, United States of America
4Division of Hematology and Blood Research Center, University of North Carolina, Chapel Hill, United States of America
5Department of Ophthalmology, Duke University School of Medicine, Durham, United States of America
6Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, United States of America
7Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, United States of America
8Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States of America
Find articles by Stephenson, D. in: PubMed | Google Scholar
1Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, United States of America
2Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, United States of America
3Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, United States of America
4Division of Hematology and Blood Research Center, University of North Carolina, Chapel Hill, United States of America
5Department of Ophthalmology, Duke University School of Medicine, Durham, United States of America
6Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, United States of America
7Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, United States of America
8Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States of America
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Reisz, J.
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1Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, United States of America
2Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, United States of America
3Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, United States of America
4Division of Hematology and Blood Research Center, University of North Carolina, Chapel Hill, United States of America
5Department of Ophthalmology, Duke University School of Medicine, Durham, United States of America
6Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, United States of America
7Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, United States of America
8Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States of America
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Key, N.
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1Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, United States of America
2Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, United States of America
3Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, United States of America
4Division of Hematology and Blood Research Center, University of North Carolina, Chapel Hill, United States of America
5Department of Ophthalmology, Duke University School of Medicine, Durham, United States of America
6Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, United States of America
7Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, United States of America
8Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States of America
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1Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, United States of America
2Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, United States of America
3Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, United States of America
4Division of Hematology and Blood Research Center, University of North Carolina, Chapel Hill, United States of America
5Department of Ophthalmology, Duke University School of Medicine, Durham, United States of America
6Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, United States of America
7Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, United States of America
8Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States of America
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1Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, United States of America
2Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, United States of America
3Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, United States of America
4Division of Hematology and Blood Research Center, University of North Carolina, Chapel Hill, United States of America
5Department of Ophthalmology, Duke University School of Medicine, Durham, United States of America
6Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, United States of America
7Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, United States of America
8Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States of America
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Spitalnik, S.
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1Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, United States of America
2Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, United States of America
3Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, United States of America
4Division of Hematology and Blood Research Center, University of North Carolina, Chapel Hill, United States of America
5Department of Ophthalmology, Duke University School of Medicine, Durham, United States of America
6Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, United States of America
7Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, United States of America
8Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States of America
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D’Alessandro, A.
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Published July 3, 2025 - More info
Patients with sickle cell disease (SCD) frequently receive red blood cell (RBC) units stored near the end of their permissible storage life. To evaluate whether storage duration influences recipient metabolism, clinical chemistry and hematological parameters, we conducted a prospective, randomized, blinded trial comparing transfusions of RBC units stored for ≤10 days versus ≥30 days. Chronically transfused adults with SCD (N=24) received three consecutive outpatient transfusions with randomized-age RBCs, and blood samples from units and recipients were analyzed by metabolomics and clinical chemistry. Transfusion of short-stored units resulted in significantly higher circulating levels of 2,3-bisphosphoglycerate, an essential regulator of oxygen unloading, up to two weeks post-transfusion. Conversely, transfusions of long-stored RBCs were associated with lower hemoglobin and RBC increments, higher iron and transferrin saturation, pro-inflammatory cytokines and metabolites, oxidative stress and markers of renal dysfunction. Plasma and RBC metabolomic profiles revealed time- and storage-age-dependent alterations, particularly affecting glycolysis, purine, and sphingolipid metabolism. Transfusion of long-stored RBCs consistently worsened laboratory surrogates of oxygen delivery and RBC efficacy, and increased the circulating levels of immunomodulatory metabolites and pro-inflammatory cytokines. These findings highlight metabolic and hematologic advantages associated with transfusing fresher RBCs in adults with SCD, independent of immediate clinical outcomes.