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Longer red blood cell (RBC) storage can improve blood logistics, increase the usefulness of autologous blood storage, and reduce donor exposure in neonatal intensive care. Better RBC storage can prevent membrane loss and preserve the secretion of adenosine 5′-triphosphate (ATP) in response to deformation. Better RBC storage may also reduce the formation of proinflammatory membrane breakdown products that lead to transfusion-related acute lung injury and the systemic inflammatory response syndrome. To improve RBC storage, the authors have attempted to maximize the production of ATP by the manipulation of pH and to minimize membrane loss through the use of membrane protectants and the manipulation of tonicity. Increasing the initial storage pH led to successively higher RBC ATP concentrations until pH 7.2 was reached, when the synthesis of 2,3-diphophoglycerate was initiated at the …