CO2 -dependent metabolic modulation in red blood cells stored under anaerobic conditions

Transfusion. 2016 Feb;56(2):392-403. doi: 10.1111/trf.13364. Epub 2015 Oct 19.


Background: Anaerobic red blood cell (RBC) storage reduces oxidative damage, maintains adenosine triphosphate (ATP) and 2,3-diphosphoglycerate (DPG) levels, and has superior 24-hour recovery at 6 weeks compared to standard storage. This study will determine if removal of CO2 during O2 depletion by gas exchange may affect RBCs during anaerobic storage.

Study design and methods: This is a matched three-arm study (n = 14): control, O2 and CO2 depleted with Ar (AN), and O2 depleted with 95%Ar/5%CO2 (AN[CO2 ]). RBCs in additives AS-3 or OFAS-3 were evenly divided into three bags, and anaerobic conditions were established by gas exchange. Bags were stored at 1 to 6°C in closed chambers under anaerobic conditions or ambient air, sampled weekly for up to 9 weeks for a panel of in vitro tests. A full metabolomics screening was conducted for the first 4 weeks of storage.

Results: Purging with Ar (AN) results in alkalization of the RBC and increased glucose consumption. The addition of 5% CO2 to the purging gas prevented CO2 loss with an equivalent starting and final pH and lactate to control bags (p > 0.5, Days 0-21). ATP levels are higher in AN[CO2 ] (p < 0.0001). DPG was maintained beyond 2 weeks in the AN arm (p < 0.0001). Surprisingly, DPG was lost at the same rate in both control and AN[CO2 ] arms (p = 0.6).

Conclusion: Maintenance of ATP in the AN[CO2 ] arm demonstrates that ATP production is not solely a function of the pH effect on glycolysis. CO2 in anaerobic storage prevented the maintenance of DPG, and DPG production appears to be pH dependent. CO2 as well as O2 depletion provides metabolic advantage for stored RBCs.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • 2,3-Diphosphoglycerate / metabolism
  • Adenosine Triphosphate / metabolism*
  • Anaerobiosis
  • Blood Preservation*
  • Carbon Dioxide / metabolism*
  • Carbon Dioxide / pharmacology
  • Erythrocytes / cytology
  • Erythrocytes / metabolism*
  • Glycolysis*
  • Humans
  • Hydrogen-Ion Concentration
  • Oxygen / metabolism


  • 2,3-Diphosphoglycerate
  • Carbon Dioxide
  • Adenosine Triphosphate
  • Oxygen