The introduction at the turn of this century of sodium citrate as an anticoagulant was a major advance in the storage of human blood, and it later made possible the creation of blood banks. Subsequent investigations established mixtures of citric acid, trisodium citrate, and dextrose (ACD solutions) as most suitable for minimal deterioration of erythrocytes during a 3-week period of refrigerated storage. Intensive studies in immunology have resulted in cross-matching and typing tests which, in turn, make possible the careful administration of homologous blood without adverse reactions.
Blood, however, is a solution as well as a suspension, and the metabolic alterations which occur during storage are manifest mainly in its extraerythrocytic moiety. The influence of these chemical changes on the recipient of the blood usually becomes appreciable only when large volumes are administered; but in massive transfusions, or for procedures assisted by extracorporeal devices, the use of even the freshest
SCHECHTER DC, PATON BC, SWAN H. Extracellular Changes in Stored BloodA Comparison of Changes in Blood Treated with ACD Solution or Cation Exchange Resins. Arch Surg. 1962;84(3):358-364. doi:10.1001/archsurg.1962.01300210092019