Anticoagulant

Citrate
Dextrose
Solution

Extemporaneous
Preparation

Name:
Date:
institute:
Introduction:

Anti-coagulant Citrate dextrose solution is a solution in water that comprises of dextrose, citric

acid, and sodium citrate. It is also known by the names Acid-citrate-dextrose solution, acid-

citrate-dextrose, or ACD. [ CITATION Mar17 \l 1033 ].

It was first prepared in the year 1943, having a pH of 5. It is stored in glass bottles, and gives

RBC’s a survival rate of 72% for 21 days. There’s very little hemolysis. The blood specimen is

preserved and erythrocyte survival is ensured with the help of Acid-citrate-dextrose solution.
[ CITATION Bry15 \l 1033 ]

Nowadays it is preserved in yellow tubes. It has replaced Heparin in procedures such as tissue

typing, and plasmapheresis.

Types of Dosage form compound:

There is dextrose, citric acid, and sodium citrate dissolved in water. Each 1000ml of the solution

comprises of the following compounds; Monohydrate Dextrose 24.5g, dihydrate sodium citrate

220g, anhydrous citric acid 7.3g, and water for dilution which is added later. The pH is

maintained at 4-5 to 5.5 no antimicrobial agent is added to the mixture. The dose is a one-time

usage container, which is transparent market by a yellow cap.

Objective for compounding:

The purpose of compounding the medicine is to ensure safe dosage transmission to the patient or

the receiver. It is necessary to calculate the correct dosage requirements before dispensing the

solution. Several calculations are made which calculate the appropriate compounding of a drug.

These calculations include;

 Determination of osmolarity

 Calculation of isotonicity
  Buffer system calculation

 Proportional calculations

 Aliquots

 Checking dilution and concentration of previously prepared medications

These collective calculations help compound the solution according to individual

requirements.

Material and Methods:

It’s relatively easy to make the anticoagulant citrate dextrose solution, provided all the required

material is there and proper method is known.

The compounds Monohydrate Dextrose 24.5g, dihydrate sodium citrate 220g, anhydrous citric

acid 7.3g are mixed together in 1000ml water. The solution is thoroughly mixed, and filtered.

After filtering, it is placed in an appropriate container and sterilized. [ CITATION Pha20 \l 1033 ]

Shelf Life and Quality Control:

The shelf-life of RBC’s with addition of ACD is 21 days. With the addition of adenine to the

mixture, the shelf life of RBCs is increased to 42 days.

For the purpose of quality control, preservatives such as EDTA, and Alsever solution are used.

These preserve the platelets.[ CITATION Lee98 \l 1033 ]

Results:

The solution prepared extemporaneously has been very efficient as a blood preservative. It can

be made easily with the required quantity of compounds. It increases the shelf-life of RBC’s in
blood by 21 days. Additionally, with adenine added to the ACD mixture, the shelf-life is

increased to 42 days. It has been a good substitute to Heparin.

Discussion:

Anticoagulant Citrate Dextrose Solution has been very beneficial, conventionally, Heparin had

been in use. Nowadays Citrate Dextrose solution has been of equal importance. It decreases

blood transfusion requirements in patients who are on renal replacement therapy. It is used as an

extracorporeal blood in the production of PRP with the help of Autologous Platelets-Rich Plasma

(PRP). As mentioned before, it increases the shelf life of RBC’s by 21 days. It preserves the

blood cells and is used in HLA phenotyping, DNA testing, and Paternity tests. In therapeutic

apheresis, it significantly helps in removal of abnormal cells and substances present in the blood.
References:

 Layron, M. (2017). Acid-Citrate-Dextrose - an overview | ScienceDirect Topics.

Retrieved April 6, 2021, from www.sciencedirect.com website:

https://www.sciencedirect.com/topics/neuroscience/acid-citrate-dextrose

 Cotton, B. A., & McElroy, L. A. (2015). Citrate-Dextrose Solutions. Encyclopedia of

Trauma Care, 321–322. https://doi.org/10.1007/978-3-642-29613-0_39

 Drugs.com. (2021). Anticoagulant Citrate Dextrose A - FDA prescribing information,

side effects and uses. Retrieved April 6, 2021, from Drugs.com website:

https://www.drugs.com/pro/anticoagulant-citrate-dextrose-a.html

 Pharmacopeial Forum. (2020). Anticoagulant Citrate Dextrose Solution. Retrieved from

Drugfuture.com website:

https://www.drugfuture.com/Pharmacopoeia/USP32/pub/data/v32270/usp32nf27s0_m51

00.html

 Osby, M., Barton, P., Lam, C. N., & Tran, M. H. (2014). Acid-citrate-dextrose Formula

A versus heparin as primary catheter lock solutions for therapeutic apheresis.

Transfusion, 54(3), 735–743. https://doi.org/10.1111/trf.12310

 Lee. (1998). Acid-Citrate-Dextrose - an overview | ScienceDirect Topics. Retrieved April

6, 2021, from www.sciencedirect.com website:

https://www.sciencedirect.com/topics/medicine-and-dentistry/acid-citrate-dextrose