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Clinical Research and Public HealthIn-Press PreviewClinical ResearchHematology Open Access | 10.1172/JCI192920

Blood-storage duration affects hematological and metabolic profiles in patients with sickle cell disease receiving transfusions

Matthew S. Karafin,1 Abby L. Grier,2 Ross M. Fasano,3 Anton Ilich,4 David Wichlan,4 Ada Chang,4 Sonjile M. James,3 Hailly E. Butler,3 Oleg Kolupaev,5 Melissa C. Caughey,6 Daniel J Stephenson,2 Julie A. Reisz,2 Nigel S. Key,4 Joshua J. Field,7 Jane A. Little,4 Steven L. Spitalnik,8 and Angelo D’Alessandro2

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

Find articles by Fasano, R. 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 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

Find articles by James, S. 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 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

Find articles by Reisz, J. 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 Key, N. 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 Field, J. 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 Little, J. 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 Spitalnik, S. 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 D’Alessandro, A. in: PubMed | Google Scholar |

Published July 3, 2025 - More info

J Clin Invest. https://doi.org/10.1172/JCI192920.
Copyright © 2025, Karafin et al. This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
Published July 3, 2025 - Version history
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Abstract

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.

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