Some of the requirements for survival of human red blood cells were studied in vitro at 25 and 37 degrees C for 1--2 weeks. During the first week at 25 degrees C in Krebs-Ringer bicarbonate medium with glucose, the cells at 2--5% hematocrit (HCT) maintained normal K+, Na+, and water contents with negligible hemolysis. After six days ion gradients decreased, preceded by decline of ATP. With adenosine, ATP was maintained for 1--2 weeks. Sustained in vitro survival of human red blood cells at 25 or 37 degrees C requires constant pHo and sufficient substrates to support a glycolytic carbon flux as well as a nitrogen flux via nucleotide turnover. In Earle's salts buffered with HEPES and supplemented with glucose, Eagle's essential vitamins, albumin, and antibiotics, suspensions at 0.1% HCT exhibited constant pH at 7.39 +/- 0.03 for at least two weeks at 37 degrees C. With glucose alone, ATP declined steadily to negligible levels despite constant pHo, but 0.1 mM adenine supported ATP for one week. Also, several amino acids partially prevented the decline of reduced glutathione during the first week at 37 degrees C. These results and current knowledge of red cell metabolism suggest a new defined medium for experiments requiring long term incubations, and extend the characterization of human red cell in vitro survival to a time period not previously studied.