Acid-citrate-dextrose or acid-citrate-dextrose solution (ACD; also known as anticoagulant-citrate-dextrose or anticoagulant-citrate-dextrose solution) is any
solution
Solution may refer to:
* Solution (chemistry), a mixture where one substance is dissolved in another
* Solution (equation), in mathematics
** Numerical solution, in numerical analysis, approximate solutions within specified error bounds
* Solu ...
of
citric acid
Citric acid is an organic compound with the formula . It is a Transparency and translucency, colorless Weak acid, weak organic acid. It occurs naturally in Citrus, citrus fruits. In biochemistry, it is an intermediate in the citric acid cycle, ...
,
sodium citrate Sodium citrate may refer to any of the sodium salts of citric acid (though most commonly the third):
* Monosodium citrate
* Disodium citrate
* Trisodium citrate
The three forms of salt are collectively known by the E number E331.
Applications
...
, and
dextrose
Glucose is a sugar with the molecular formula , which is often abbreviated as Glc. It is overall the most abundant monosaccharide, a subcategory of carbohydrates. It is mainly made by plants and most algae during photosynthesis from water an ...
in water. It is mainly used as an
anticoagulant
An anticoagulant, commonly known as a blood thinner, is a chemical substance that prevents or reduces the coagulation of blood, prolonging the clotting time. Some occur naturally in blood-eating animals, such as leeches and mosquitoes, which ...
(in yellow top tubes) to preserve blood specimens required for
tissue typing Tissue typing is a procedure in which the tissues of a prospective donor and recipient are tested for compatibility prior to transplantation. Mismatched donor and recipient tissues can lead to rejection of the tissues. There are multiple methods of ...
. It is also used during procedures such as
plasmapheresis
Plasmapheresis (from the Greek language, Greek πλάσμα, ''plasma'', something molded, and ἀφαίρεσις ''aphairesis'', taking away) is the removal, treatment, and return or exchange of blood plasma or components thereof from and to the ...
instead of
heparin
Heparin, also known as unfractionated heparin (UFH), is a medication and naturally occurring glycosaminoglycan. Heparin is a blood anticoagulant that increases the activity of antithrombin. It is used in the treatment of myocardial infarction, ...
.
Formulation
Two solutions (A and B) are defined by the
United States Pharmacopeia
The ''United States Pharmacopeia'' (''USP'') is a pharmacopeia (compendium of drug information) for the United States published annually by the over 200-year old United States Pharmacopeial Convention (usually also called the USP), a nonprofi ...
. They have the following properties:
To make use:
Dissolve the ingredients and mix. Filter until clear.
History
Blood storage
ACD was invented by Loutit et al. in 1943 for preserving whole blood. They found that the mixture offers better red blood cell survival than the then state-of-the-art, MRC 1940 (trisodium citrate plus glucose). The old solution also
caramelize when autoclaved, while the new one does not due to higher acidity. As a result, blood can now be stored for much longer, up to 21 days.
ACD was developed into CPD (citrate-phosphate-dextrose) in 1957, a version with phosphate added intended to reduce phosphate leakage from red blood cells. It does not improve shelf life appreciably, but patient recovery is improved. A later improvement was CPD with adenine (CPDA-1), which boosted RBC survival to five weeks when combined with plastic bags. CPD, in combination with adenine-mannitol additives such as SAGM, is ''the'' current
blood bank
A blood bank is a center where blood gathered as a result of blood donation is stored and preserved for later use in blood transfusion. The term "blood bank" typically refers to a department of a hospital usually within a clinical pathology labora ...
preservative as of 2012.
[
Although human blood is generally stored using newer formulations, the uptake of such technology is slower in veterinary medicine. From experimentation on horse and donkey blood, it does seem that the newer human-blood storage technogies also translate to improvements in animal blood storage.
]
Apheresis
ACD is first described for use in apheresis
Apheresis ( ἀφαίρεσις (''aphairesis'', "a taking away")) is a medical technology in which the blood of a person is passed through an apparatus that separates one particular constituent and returns the remainder to the circulation. ...
in 1977. Citrate, typically in the form of ACD solutions, is now preferred over heparin because it is cheap, safe, and cleared out of the system faster. Use of ACD is universal for centrifuge-based systems, while membrane systems may use either. Heparin is still used for high-volume procedures, as infusing too much citrate with the returned blood can cause toxicity from the chelating action, mainly hypocalcemia
Hypocalcemia is a medical condition characterized by low calcium levels in the blood serum. The normal range of blood calcium is typically between 2.1–2.6 mmol/L (8.8–10.7 mg/dL, 4.3–5.2 mEq/L), while levels less than 2.1 ...
.
References
{{reflist
External links
US Pharmacopeia
Anticoagulants