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A clinical evaluation of citrate-phosphate-dextrose-adenine blood
Insights
Citrate-phosphate-dextrose (CPD) with adenine extends red blood cell storage to 5 weeks, maintaining viability and reducing waste. This blood preservation method shows comparable transfusion reaction rates to older acid-citrate-dextrose (ACD) methods.
Area of Science:
- Blood banking and transfusion medicine
- Biochemistry of stored blood
- Clinical hematology
Background:
- Traditional acid-citrate-dextrose (ACD) solutions limit red blood cell (RBC) storage.
- Extending RBC shelf-life is crucial for blood supply management and patient care.
Purpose of the Study:
- To evaluate the efficacy of citrate-phosphate-dextrose (CPD) with adenine as a storage solution for RBCs.
- To compare the biochemical and post-transfusion viability of CPD-adenine stored blood with ACD stored blood.
Main Methods:
- Whole blood and packed red cells were stored in polyvinyl-chloride bags with CPD-adenine.
- Red cell adenosine triphosphate (ATP) and 2,3-diphosphoglycerate (DPG) levels were measured.
- Post-transfusion viability of stored RBCs was assessed.
- Clinical transfusion reactions were compared between CPD-adenine and ACD groups.
Main Results:
- CPD-adenine maintained RBC ATP levels above 70% for 4 weeks and 5 weeks (whole blood).
- RBC 2,3-DPG levels decreased over storage, reaching ~30% after 3 weeks.
- 24-hour post-transfusion viability remained high (~80%) after 4 weeks and ~77% after 5 weeks.
- CPD-adenine blood showed a similar transfusion reaction rate (3.5%) compared to ACD blood (4.1%).
- Storage duration extended to 5 weeks for CPD-adenine, reducing outdating by at least 50%.
Conclusions:
- CPD-adenine is an effective additive solution for extending RBC storage to 5 weeks.
- Extended storage with CPD-adenine maintains adequate RBC viability and function.
- This preservation method improves blood inventory management by reducing wastage.
Abstract:
(1) Blood was stored in polyvinyl-chloride bags containing citrate-phosphate-dextrose (CPD) with adenine in a final concentration of 0.25 mM. (2) Red cell ATP was well maintained (greater than 70% of original) for 4 weeks in whole blood as well as in red cell concentrate (PCV 85 plus or minus 2%). After 5 weeks the ATP level was about 70% in whole blood and about 40% in red cell concentrate. (3) Red cell 2,3-diphosphoglycerate (DPG) was about 60% of the original after 2 weeks and about 30% after 3 weeks of storage when stored both as whole blood and as red cell concentrate. (4) The red cell 24-hour post-transfusion viability was about 80% after 4 weeks of storage both as whole blood and as red cell concentrate. After 5 weeks of storage the 24-hour viability was 78.7 plus or minus 3.5% in whole blood and 76.5 plus or minus 6.7% in red cell concentrate. (5) 820 patients received 3,238 units of CPD-adenine blood, and 761 patients serving as controls received 2,807 units of acid-citrate-dextrose (ACD) blood. The frequency of transfusion reactions was 3.5% for patients receiving CPD-adenine blood and 4.1% for the control group. (6) The maximum storage time was set at 5 weeks for the CPD-adenine blood and 3 weeks for the ACD blood. The longer preservation time decreased out-dating by at least 50%.