Storage differentially impacts alloimmunization to distinct red cell antigens following transfusion in mice

Cheryl L. Maier, Ryan P. Jajosky, Seema R. Patel, Hans P. Verkerke, Megan D. Fuller, Jerry William Allen, Patricia E. Zerra, Ross M. Fasano, Satheesh Chonat, Cassandra D. Josephson, David R. Gibb, Stephanie C. Eisenbarth, C. John Luckey, Krystalyn E. Hudson, Jeanne E. Hendrickson, Connie M. Arthur, Sean R. Stowell*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Introduction: The impact of blood storage on red blood cell (RBC) alloimmunization remains controversial, with some studies suggesting enhancement of RBC-induced alloantibody production and others failing to observe any impact of storage on alloantibody formation. Since evaluation of storage on RBC alloimmunization in patients has examined antibody formation against a broad range of alloantigens, it remains possible that different clinical outcomes reflect a variable impact of storage on alloimmunization to specific antigens. Methods: RBCs expressing two distinct model antigens, HEL-OVA-Duffy (HOD) and KEL, separately or together (HOD × KEL), were stored for 0, 8, or 14 days, followed by detection of antigen levels prior to transfusion. Transfused donor RBC survival was assessed within 24 h of transfusion, while IgM and IgG antibody production were assessed 5 and 14 days after transfusion. Results: Stored HOD or KEL RBCs retained similar HEL or KEL antigen levels, respectively, as fresh RBCs, but did exhibit enhanced RBC clearance with increased storage age. Storage enhanced IgG antibody formation against HOD, while the oppositive outcome occurred following transfusion of stored KEL RBCs. The distinct impact of storage on HOD or KEL alloimmunization did not appear to reflect intrinsic differences between HOD or KEL RBCs, as transfusion of stored HOD × KEL RBCs resulted in increased IgG anti-HOD antibody development and reduced IgG anti-KEL antibody formation. Conclusions: These data demonstrate a dichotomous impact of storage on immunization to distinct RBC antigens, offering a possible explanation for inconsistent clinical experience and the need for additional studies on the relationship between RBC storage and alloimmunization.

Original languageEnglish (US)
Pages (from-to)457-462
Number of pages6
Issue number3
StatePublished - Mar 2023


  • alloimmunization
  • blood storage
  • transfusion

ASJC Scopus subject areas

  • Hematology
  • Immunology and Allergy
  • Immunology


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