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Red blood cell storage lesion

The introduction of omics technologies, in particular proteomics and metabolomics in the field of transfusion medicine, has unveiled the complexity of the storage lesion. Even though it is now universally accepted that the storage lesion affects red cell survival upon transfusion and thus, theoretically, the safety and effectiveness of the transfusion therapy, no significant association between storage duration and transfusion outcomes has been observed in any of the large‐scale randomized clinical trials performed so far. This disconnection between laboratory and clinical evidence may be in part reconciled by the appreciation of the underlying biological variability among donors and recipients, utterly affecting the severity of the storage lesion and the clinical effects of the transfusion therapy. While in the last few years the transfusion community has been split between those seeing the glass half full or half empty, considerations on the influence of biological variability and prestorage variables (e.g. handling and processing) on the final quality of packed red blood cells have prompted a re‐assessment of whether we do really know what is in the glass (the final blood product). Controversy persists between the supporters of the clinical irrelevance of the storage lesion and those questioning the design and statistical power of the evidence‐based studies looking for a correlation between storage duration and untoward consequences of transfusion. In the meantime, alternative storage strategies and solutions have been designed that promise to deliver better quality blood products for both factions.