Red Cell and Platelet Concentrates from Blood Collected into Half- Strength Citrate Anticoagulant: Improved Maintenance of Red Cell 2,3-Diphosphoglycerate in Half-Citrate Red Cells

Abstract

This study confirms previous work suggesting equivalent in vitro properties in blood components prepared from donations collected into half-citrate preservative (HCPD) compared to components derived from donations collected into standard citrate-phosphate-dextrose (CPD) preservatives. In addition, red cell products harvested from HCPD donations showed significantly improved maintenance of pH over storage, and this was reflected in improved maintenance of intracellular 2,3-diphosphoglycerate (2,3-DPG). This effect was observed in whole blood and in red cells suspended in a phosphate-containing additive solution (Tuta AAS). Collection into HCPD also improved 2,3-DPG maintenance in red cell concentrates processed following an 18-hour hold at 22 °C. These improvements were less pronounced in red cells suspended in a non-phosphate-containing medium (Fenwal Adsol) in which a higher pH was maintained even in units collected in CPD. Platelets harvested from HCPD blood and suspended in plasma showed equivalent quality to platelets from standard donations. Some deterioration of platelet properties was observed when HCPD platelets were stored in a non-citrate synthetic medium. Together with data indicating improved coagulation factor stability, these results suggest that collection into HCPD improves stored blood quality and may also allow logistical benefits in blood component preparation.

Stability of Blood Coagulation Factors and Inhibitors in Blood Drawn into Half-Strength Citrate Anticoagulant

“…The drawing of blood into half-strength CPD improves the maintenance of 2,3-bisphosphoglycerate during storage of red-cell concentrate [4] as well as red cells suspended in additive solutions containing citrate, phosphate and ade nine, but no chloride [5,6], Citrate in the red cell additive solution (RAS) offers possibilities to a further improvement of the storage conditions for red cells [5][6][7]. Thus, there are good reasons to lower the citrate concentration in the anti coagulant in order to avoid an increased citrate load in mas sive transfusion when plasma and red cell suspensions are transfused simultaneously.…”

“…Recent studies have shown that a half-strength citrate CPD solution (0.5CPD) improves the maintenance of eryth rocyte 2,3-bisphosphoglycerate (BPG) during storage of red cell concentrates [4], This effect is even more pro nounced when the red cells are stored in an additive solution containing citrate and no chloride [5,6]. …”

Clinical and Laboratory Experience with Erythrocyte and Platelet Preparations from a 0.5 CPD Erythro-Sol Opti System

“…It gives to the blood a higher pHe as well as pHi [9,12], The latter effect prob ably explains most of the better maintenance of 2,3-DPG and P50-Since PCs are often prepared from the collected whole blood in addition to other components, it is important to know if 0.5CPD allows the preparation of platelets with similar yields or if it has any adverse effects on platelets with respect to platelet transfusions. No such effects were observed in a previous study, though [16].…”

“…Rapid cooling of the blood to 20°C is a way to counteract the loss, but even then about 60% of the original 2,3-DPG content is lost within 16 h [24], thus at a rate of about 4%h. This initial loss is less rapid when the blood is collected in 0.5CPD but great individual variations are seen [12,16].…”

“…Much less information is available concerning 0.5CPD. Favorable data were reported by Farrugia et al [16] with PRP-derived platelet concentrates. Gulliksson et al [17] presented in vitro data indicating the usefulness of this anticoagulant when 0.5CPD BCs were used as source.…”