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Red cells are stored at 1–6°C for 21–42 days depending on the anticoagulant–preservative solution used. For optimum inventory management, most blood centers use preservatives that allow 42‐day storage. The end of the storage period is referred to as the expiration date or the “outdate.” The cells must be stored in refrigerators with good air circulation and that are designed for blood storage. Household refrigerators are not suitable. The temperature in the refrigerator must be monitored and should be recorded periodically (continuously is preferable), at least every 4 hours. There should be an alarm system to warn staff if the temperature moves outside the acceptable limits. When blood is transported to the patient care area for transfusion, it may be allowed to warm to 10°C and still be suitable for return to the blood bank and reissue to other patients [24, 30].

Table 5.7 Changes that occur during red cell storage: the storage lesion.

Source: Adapted from Hess JR. Measures of stored red blood cell quality. Vox Sang 2014; 107:1–9.

Increase	Decrease
Lactate	ATP
Pyruvate	2,3‐DPG
Ammonia	Intracellular potassium
Intracellular sodium	pH
Membrane vesicles	Intravascular recovery
Plasma hemoglobin	Oxygen release
Free iron	Nitric oxide secretion

ATP, adenosine triphosphate; 2,3‐DPG, 2,3‐diphosphoglycerate.

Blood components must be maintained under proper storage conditions during transportation from the blood center to the hospital transfusion service. Various containers are available for this purpose, and these processes are standard and work well in developed countries. However, in developing or undeveloped parts of the world, usually these kinds of containers are not available and red cells may not be refrigerated or stored properly during this transportation. This is also an issue in military settings, where it also important that these containers be lightweight.