{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:52:17Z","timestamp":1787165537589,"version":"build-2736575974"},"reference-count":84,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,11,3]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">The red blood cell (RBC) storage lesion is a series of morphological, functional, and metabolic changes that RBCs undergo following collection, processing, and refrigerated storage for clinical use. Since the biochemical attributes of the RBC unit shifts with time, transfusion of older blood products may contribute to cardiac complications, including hyperkalemia and cardiac arrest. We measured the direct effect of storage age on cardiac electrophysiology and compared it with hyperkalemia, a prominent biomarker of storage lesion severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Donor RBCs were processed using standard blood\u2010banking techniques. The supernatant was collected from RBC units, 7 to 50\u00a0days after donor collection, for evaluation using Langendorff\u2010heart preparations (rat) or human induced pluripotent stem cell\u2013derived cardiomyocytes. Cardiac parameters remained stable following exposure to \u201cfresh\u201d supernatant from red blood cell units (day 7: 5.8\u00b10.2\u00a0mM\u00a0K\n                      <jats:sup>+<\/jats:sup>\n                      ), but older blood products (day 40: 9.3\u00b10.3\u00a0mM\u00a0K\n                      <jats:sup>+<\/jats:sup>\n                      ) caused bradycardia (baseline: 279\u00b15 versus day 40: 216\u00b118 beats per minute), delayed sinus node recovery (baseline: 243\u00b18 versus day 40: 354\u00b123\u00a0ms), and increased the effective refractory period of the atrioventricular node (baseline: 77\u00b12 versus day 40: 93\u00b17\u00a0ms) and ventricle (baseline: 50\u00b13 versus day 40: 98\u00b110\u00a0ms) in perfused hearts. Beating rate was also slowed in human induced pluripotent stem cell\u2013derived cardiomyocytes after exposure to older supernatant from red blood cell units (\u221275\u00b19%, day 40 versus control). Similar effects on automaticity and electrical conduction were observed with hyperkalemia (10\u201312\u00a0mM\u00a0K\n                      <jats:sup>+<\/jats:sup>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">This is the first study to demonstrate that \u201colder\u201d blood products directly impact cardiac electrophysiology, using experimental models. These effects are likely caused by biochemical alterations in the supernatant from red blood cell units that occur over time, including, but not limited to hyperkalemia. Patients receiving large volume and\/or rapid transfusions may be sensitive to these effects.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.120.017748","type":"journal-article","created":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T05:00:29Z","timestamp":1603342829000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Potential Consequences of the Red Blood Cell Storage Lesion on Cardiac Electrophysiology"],"prefix":"10.1161","volume":"9","author":[{"given":"Marissa","family":"Reilly","sequence":"first","affiliation":[{"name":"Sheikh Zayed Institute for Pediatric Surgical Innovation Children\u2019s National Hospital Washington DC"},{"name":"Children\u2019s National Heart Institute Children\u2019s National Hospital Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal D.","family":"Bruno","sequence":"additional","affiliation":[{"name":"Sheikh Zayed Institute for Pediatric Surgical Innovation Children\u2019s National Hospital Washington DC"},{"name":"Division of Critical Care Medicine Children\u2019s National Hospital Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomas M.","family":"Prudencio","sequence":"additional","affiliation":[{"name":"Sheikh Zayed Institute for Pediatric Surgical Innovation Children\u2019s National Hospital Washington DC"},{"name":"Children\u2019s National Heart Institute Children\u2019s National Hospital Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Ciccarelli","sequence":"additional","affiliation":[{"name":"Sheikh Zayed Institute for Pediatric Surgical Innovation Children\u2019s National Hospital Washington DC"},{"name":"Children\u2019s National Heart Institute Children\u2019s National Hospital Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devon","family":"Guerrelli","sequence":"additional","affiliation":[{"name":"Sheikh Zayed Institute for Pediatric Surgical Innovation Children\u2019s National Hospital Washington DC"},{"name":"Children\u2019s National Heart Institute Children\u2019s National Hospital Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raj","family":"Nair","sequence":"additional","affiliation":[{"name":"Sheikh Zayed Institute for Pediatric Surgical Innovation Children\u2019s National Hospital Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manelle","family":"Ramadan","sequence":"additional","affiliation":[{"name":"Sheikh Zayed Institute for Pediatric Surgical Innovation Children\u2019s National Hospital Washington DC"},{"name":"Children\u2019s National Heart Institute Children\u2019s National Hospital Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi L. 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