The document discusses the history and development of blood preservation, transport, and storage. Some key points discussed include: - Blood groups were discovered in 1900 by Karl Landsteiner, allowing safer blood transfusions. Rous and Turner found glucose extends red blood cell life in storage in 1902. - The first anticoagulants and preservation solutions were developed by Rous and Turner, enabling actual blood banking. Stored blood was first used in WWI. - Common anticoagulant preservative solutions for collection and storage include ACD, CPD, and CPDA-1/2, which prevent coagulation and preserve red blood cell function. - Additive systems were developed to extend

1. PRESERVATION,TRANSPORT,AND
STORAGE OF BLOOD

2. The transfusion of blood remained mysteriously unsafe until the
discovery of blood groups by Karl Landsteiner in 1900. Clotting of blood
before donor’s blood could be transfused into the recipient.two years
later Rous and Turner found that glucose is useful in extending the life
of red cells under storage conditions.
The development of first anticoagulants preservation solution by Rous
and Turner paved the way for actual banking practice of bood
transfusion.

3. Stored human blood was first time used during the first world war.The
next important development occurred during the second world war
(1943),when an acid citrate dextrose (ACD) solution was introduced by
Loutit and Mollison for clinical use.
ANTICOAGULANTS PRESERVATIVE SOLUTIONS
Several anticoagulants preservative solutions are now available for
whole blood collection snd storage.they are:
1. Acid Citrate Dextrose (ACD)
2. Citrate phosphate dextrose (CPD)

4. 3 Citrate phosphate Dextrose Adenine (CPDA)
The Chemical composition of these anticoagulant preservative solution
is given in table---
15 ml of ACD & 14 ml of CPD or CPDA is used for preserving 100 ml of
blood. The main purpose of these anticoagulant preservative solution is
to fold—
• To prevent coagulation
• To preserve the life and function of Red Blood Cells so as to have
maximum post transfusion survival.

5. Composition of various anticoagulant preservative
solutions:
Chemical ACD CPD CPDA
Tri-Sodium Citrate (Di-
hydrate)
22.0 g 26.30 g 26.30 g
Citric Acid (Mono-
hydrate)
8.0 g 3.27 g 3.27 g
Dextrose 24.6 g 25.50 g 31.8 g
Sodium dihydrogen
phosphate (Monohydrate)
--- 2.28 g 2.22 g
Adenine --- --- 0.275 g
Distilled Water To make 1 L To make 1 L To make 1 L

6. Blood stored at 2-6°c in ACD solution for 31 days has post transfusion
survival of more than 70% after 24 hours. The blood stored in CPD solution
has better post transfusion survival after 21 days than ACD due to slightly
higher pH because of phosphate compound.
Blood stores in CPDA has improved the post transfusion survival of red cells
to 35 days because of enhanced ATP production and better preservation of
2, 3 Diphospho-glycerate, CPDA is the anticoagulant preservative most
commonly used today.

7. Functions of various chemical used in
anticoagulant preservatives solutions
1. Citrate
Citrate is used as most valuable anticoagulant since its introduction. It acts by
chelating calcium. It is one of the main ingredients of anticoagulant preservative
solution used for storage of blood.
2. Dextrose
Rous and Turner in 1916 found that addition of glucose prolongs the survival of red
cells. Glucose is necessary for the metabolism of stored red cells. The glucose
passes from plasma into the red cells and is utilized for energy production. The
principle pathway of the energy production in the red cells is by the glycolytic
breakdown of glucose into lactate through anaerobic glycolysis. The various
intermediaries formed are necessary for maintaining their ability to deliver oxygen
to the tissues through the generation of 2,3 diphosphoglycerate (2,3-DPG). The
viability correlates with the level of adenosine tri-phosphate (ATP).

8. 3. Citric Acid
Citric Acid prevents the carmalization of glucose in citrate dextrose
solution during autoclaving. Citric acid is a fairly weak tribasic
hydroxyacid. Along with trisodium citrate which is alkaline, it gives an
optimal pH, and as such has got least deleterious effect on the red
cells.
4. Adenine
Simon 1962 showed that addition of adenine in modified CPD solution
improved the viability as evidenced by increase in the post transfusion
survival of red cells to 35 days because of enhanced ATP production.
5. Citrate Phosphate Dextrose Adenine (CPDA)
In this the amount of adenine is increased to 0.55 g and that of
dextrose to 0.44 g. Clinical trials indicated CPDA-2 as better
anticoagulant preservative solution that CPDA-1.

9. Additive Systems
To extend the red cells storage to 42 days and to harvest maximum amount
of plasma, additive systems are now available in which the storage
environment of red cells is altered by adding certain nutrients after
removal of plasma.
Whole blood is drawn into the primary pack containing CPD or CPD2 (CPD
with twice the dextrose). The blood after collection id centrifuged and
plasma is removed for blood component preparation into second bag.
After removing most of the plasma from the primary pack, Adenine Saline
(AS) a nutritive solution in an attached satellite bag is added to the packed
cells, which provides better viability to red cells. The chemical composition
of some commercially available Additive System is given in the table.

10. Chemical Adsol system Fenwal Nutricel system Cutter Biological
Primary Bag CPD
g/63 ml
Additive AS-1
g/100 ml
Primary Bag CP2D
g/63 ml
Additive AS-3
g/100 ml
Sodium Citrate 1.66 -- 1.66 0.588
Dextrose 1.61 2.2 3.22 1.10
Citric Acid 0.206 -- 0.206 0.042
Sodium
Dihydrogen
Phosphate
0.140 -- 0.140 0.276
Adenine -- 0.027 -- 0.030
Mannitol -- 0.750 -- --
Sodium Chloride -- 0.900 -- 0.410

11. Additive system has following advantage
• Extends the storage of red blood cells to 42 days and reduces the out
dating of blood.
• Lowers the viscosity of packed red cells for ease of transfusion.
• Maximum amount of fresh plasma is harvested thus optimizing the
production of platelets & cryoprecipitate.

12. Storage temperature for Blood
Blood must always be stored at a temperature of 2-6°c in a special type
of refrigerators/cold room having temperature monitoring system and
alarm. The main reasons of storing blood within this temperature range
are:
1. To keep the rate of glycolysis at a lower level so that the dextrose is
not used too quickly.
2. To minimize the proliferation of any bacterial contamination, which
might have entered the blood unit during venipuncture.
3. To minimize the rate of diffusion of electrolytes across cell
membrane.

13. The lower limit of +2°C is
also very important
because red blood cells are
very sensitive to freezing.
As such freezing should be
avoided as it causes the
cells to haemolyse (unless
they have been treated
with glycerol for long term
preservation).