Haematology: red cell storage lesion: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Haematology: red cell storage lesion

Sample item

A trauma patient receives many units of red cells stored for more than three weeks. Which pair of changes in the stored units contributes to the metabolic disturbance?

AFall in plasma lactate and rise in red cell glucose uptakeBRise in extracellular pH and rise in red cell ATPCRise in extracellular potassium and fall in red cell 2,3-BPGDFall in extracellular potassium and rise in red cell 2,3-BPG

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Rise in extracellular potassium and fall in red cell 2,3-BPG

During storage the red cell sodium-potassium pump slows, so potassium leaks out, and 2,3-BPG and ATP fall while lactate accumulates and pH drops. Depleted 2,3-BPG shifts the oxygen dissociation curve to the left until the cells regenerate it after transfusion.

Option by option

A. Fall in plasma lactate and rise in red cell glucose uptake
Lactate accumulates in stored blood as red cells use anaerobic glycolysis.
B. Rise in extracellular pH and rise in red cell ATP
Stored blood becomes more acidic, and red cell ATP falls with storage time.
C. Rise in extracellular potassium and fall in red cell 2,3-BPG (correct)
Correct. Potassium leaks into the supernatant and 2,3-BPG falls, impairing oxygen release until regenerated.
D. Fall in extracellular potassium and rise in red cell 2,3-BPG
Potassium rises, not falls, and 2,3-BPG declines during storage rather than increasing.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is C, Rise in extracellular potassium and fall in red cell 2,3-BPG. During storage the red cell sodium-potassium pump slows, so potassium leaks out, and 2,3-BPG and ATP fall while lactate accumulates and pH drops.

Why is "Fall in plasma lactate and rise in red cell glucose uptake" not the answer?

Lactate accumulates in stored blood as red cells use anaerobic glycolysis.

Why is "Rise in extracellular pH and rise in red cell ATP" not the answer?

Stored blood becomes more acidic, and red cell ATP falls with storage time.

Why is "Fall in extracellular potassium and rise in red cell 2,3-BPG" not the answer?

Potassium rises, not falls, and 2,3-BPG declines during storage rather than increasing.

What concept does this question test?

It tests Haematology: red cell storage lesion in Pathology. Depleted 2,3-BPG shifts the oxygen dissociation curve to the left until the cells regenerate it after transfusion.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Haematology: red cell storage lesion?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.