ACID-CITRATE-DEXTROSE (ACD) solution is the most widely used anticoagulant and preservative of blood stored for transfusion. However, blood stored in ACD solution undergoes undesirable biochemical alterations. The ACD solution immediately increases the plasma citrate concentration and lowers the pH of the blood to 6.8. During storage there is an increase in blood ammonium, plasma potassium, plasma hemoglobin, phosphate, lactate, and pyruvate, and a further reduction of the pH to approximately 6.5 by the end of the second week of storage. Because large amounts of blood with abnormal electrolyte concentrations may be hazardous to recipients, we have attempted to restore this blood to approximate biochemical normalcy. This has been accomplished by passing the blood over a combination of anion and cation exchange resins in a single column (monobed).
Removal of Accumulated Cations
The deleterious effects of administration of blood with excess ammonium and potassium are well known. Elevated ammonium concentrations may
Sandler JL, Nealon TF, Gibbon JH. Restoration of Stored Bank Blood to Biochemical Normalcy. JAMA. 1962;179(3):201-203. doi:10.1001/jama.1962.03050030015004