Reduced deformability of stored red blood cells is associated with generation of extracellular vesicles

M. J. McVey, W. M. Kuebler, A. Orbach, D. Arbell, O. Zelig, G. Barshtein*, S. Yedgar

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Throughout storage, red blood cells (RBCs) undergo detrimental changes in viability and their ability to effectively transport oxygen. RBC storage lesions are mediated, in part, by a progressive loss of cell deformability, and associated with the release of extracellular vesicles (EVs). Accumulation of EVs during the storage of RBCs correlates with a decrease in RBC surface area to volume ratio. Similarly, the loss of RBC-deformability is associated with loss of RBC surface area to volume ratio. In this study we thus tested whether loss of RBC-deformability is associated with increased RBC-EV production during blood storage. EVs obtained by differential centrifugation of stored RBCs (non-leukoreduced non-irradiated or leukoreduced γ-irradiated RBCs stored 35 or 28 days respectively) were enumerated by high-sensitivity flow cytometry. RBC deformability was quantified, using a cell-flow-properties-analyzer, by measuring the median cell elongation ratio (MER) and percentage of low and high deformable cells in the population (%, LDFC, and HDFC, respectively). The number of EVs was inversely correlated with the MER and positively correlated with the %LDFC with both measures showing highly significant logarithmic dependence with EV levels in stored RBCs. Considering how highly deformable cells did not correlate with EV formation as compared with low deformable RBCs we propose that the formation of EVs is a key factor leading to increased RBC-rigidity.

Original languageAmerican English
Article number102851
JournalTransfusion and Apheresis Science
Issue number5
StatePublished - Oct 2020

Bibliographical note

Funding Information:
This study was supported by a grant from the Israel Science Foundation (to G. Barshtein; 341/18). M.J. McVey is supported by a Canadian Institute of Health Research Vanier Scholarship . We thank Ms. Olga Fredman (The Hebrew University, Faculty of Medicine) and B.M. Alyan Muna (Blood Bank, Hadassah University Hospital) for their technical assistance.

Publisher Copyright:
© 2020


  • Extracellular vesicles
  • RBC deformability
  • RBC storage
  • Red blood cells


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