Sodium citrate was recommended in 1914 as an anticoagulant for the preservation of blood. Satisfactory erythrocyte survival could be maintained for only 5 days in this solution. Critical decomposition of blood was held in abeyance up to a 12-day limit by the incorporation of dextrose as a pabulum for continuing cellular metabolism during refrigerated storage. The viability period was extended further, to 21 days, during World War II by the addition of a citric acid buffering substrate. This triple formula constitutes the now widely used acid-citrate-dextrose (ACD) solution.During storage, serious biochemical changes occur in ACD bank blood which convert it into a potentially hazardous therapeutic agent. While convenient for routine use to combat anemia or moderate hypovolemia, blood preserved in ACD may prove dangerous or even lethal when administered in large amounts, as, for example, in exchange transfusions, massive replacement therapy, or the priming of extracorporeal circuits such
SCHECHTER DC, SWAN H. Biochemical Alterations of Preserved Blood: Results in Two Different Citrate Solutions (ACD and CPD). Arch Surg. 1962;84(3):269–276. doi:10.1001/archsurg.1962.01300210003001
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