Carnitine levels are associated with hemolysis and vesiculation in vivo and in vitro in humans and mice. (A) In REDS RBC Omics index donors, (B) depletion of carnitine pools in end-of-storage RBCs was associated with elevated hemolysis. These observations were validated in the recalled donor population, in which depletion of AC pools corresponded to (C) increased vesiculation rates and (D) hemolysis. (E) Interrogation of the REDS vein-to-vein database, in which lowest end-of-storage carnitine levels were associated with significantly lower Hb increments in donors receiving single-unit transfusion for units stored >4 to 5 weeks (F), especially for the last week of storage (F). Metabolomics (G) and lipidomics analyses (G’) show that AC pools are restored by l-carnitine supplementation, but not d-carnitine, in stored FVB mouse RBCs (poor storer strain characterized by high levels of storage-induced lipid peroxidation). l-carnitine supplementation boosts PTR of stored FVB RBCs (H).

Carnitine levels are associated with hemolysis and vesiculation in vivo and in vitro in humans and mice. (A) In REDS RBC Omics index donors, (B) depletion of carnitine pools in end-of-storage RBCs was associated with elevated hemolysis. These observations were validated in the recalled donor population, in which depletion of AC pools corresponded to (C) increased vesiculation rates and (D) hemolysis. (E) Interrogation of the REDS vein-to-vein database, in which lowest end-of-storage carnitine levels were associated with significantly lower Hb increments in donors receiving single-unit transfusion for units stored >4 to 5 weeks (F), especially for the last week of storage (F). Metabolomics (G) and lipidomics analyses (G’) show that AC pools are restored by l-carnitine supplementation, but not d-carnitine, in stored FVB mouse RBCs (poor storer strain characterized by high levels of storage-induced lipid peroxidation). l-carnitine supplementation boosts PTR of stored FVB RBCs (H).

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