Which of the following correctly describes a change seen in packed red cells during prolonged refrigerated storage (the storage lesion)?

• A Falling 2,3-BPG levels impair immediate oxygen unloading, and extracellular potassium rises progressively ✓
• B Rising 2,3-BPG levels shift the oxygen dissociation curve to the right
• C pH rises steadily due to citrate metabolism
• D ATP content increases, improving red cell deformability

Explanation

During storage, 2,3-BPG falls sharply over the first one to two weeks, shifting the oxyhaemoglobin curve leftward and reducing oxygen delivery until regenerated after transfusion. Potassium leaks out of cells into the additive solution, raising extracellular K+, while pH and ATP both fall. Option B states the opposite direction for 2,3-BPG, which is the discriminating fact examiners test.

Reference: Williams Hematology, 10th ed.

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