Approximately 25 percent of black blood donors have an elevated red blood cell (RBC) sodium (Nai) level compared with white donors. This elevation results in a significant increase in the mean Nai from black (9.00 +/- 2.96 mmoles/l RBC) as compared to white blood donors (7.04 +/- 1.48 mmoles/l RBC, p less than 0.001). Red blood cells from four black donors with mean Nai levels of 15 +/- 2.8 mmoles/l RBC were stored for 35 days in citrate-phosphate-dextrose-adenine and compared to that of four donors with normal levels of Nai. Serial measurements of red blood cell adenosine triphosphate, diphosphoglycerate, glucose-6-phosphate dehydrogenase, pyruvic kinase, lactate production rates, and intracellular cations showed no differences between the two donor groups. Furthermore, the mean 24-hour posttransfusion survival was not significantly different for the high Nai group (83.2 +/- 5.6%) as compared with the control group (82.3 +/- 6.9%). Based on this study, it is not necessary to eliminate individuals with an elevated red blood cell Nai level as blood donors.