Abstract: Red blood cell (RBC) transfusion remains a cornerstone of therapy for the management of anemia and hemorrhagic shock. However, during ex vivo storage, RBCs undergo progressive biochemical and metabolic alterations, a phenomenon termed "storage lesion". Such lesions can impair oxygen-carrying capacity, increase hemolysis risk, and exacerbate oxidative stress, thereby exerting adverse effects on patients' clinical outcomes. In recent years, the impact of storage lesion has attracted growing attention, particularly with respect to adverse events associated with blood transfusion. Although the clinical prognosis of transfusing stored, damaged RBCs remains controversial, accumulating evidence indicates that RBCs with longer storage time are associated with adverse clinical outcomes, including an increased risk of infection, organ dysfunction, and higher mortality rates. Therefore, in the context of tight blood supply, the rational management of RBCs storage time and research on new technologies to preserve RBC viability have become crucial. In the future, efforts should focus on elucidating the mechanisms underlying RBC storage lesion, optimizing transfusion plan, and expanding blood supply to ensure the safety of patients and the efficacy of transfusion therapy.

Key words: Red blood cell, Storage lesion, Clinical prognosis