R. Ben Dawson

Adenine Blood Preservation

The recent Food and Drug Administration (U.S.) approval of a new blood preservative (CPDA-1) which contains adenine not only introduces a new blood product into the American blood banking system, but also heralds the advent of novel approaches to blood product preservation. The use of adenine to effect maintenance of red cell adenosine triphosphate (ATP), and hence to prolong storability, has a well-founded biochemical rationale. Effects of adenine on red cell metabolism are generally well understood, but effects on other blood components have not been fully delineated. The efficacy of adenine preservatives in enhancing the duration of red cell storage appears to outweigh the small risk of toxicity from free adenine. Clinical use of millions of units of adenine-preserved blood in Europe during more than a decade has resulted in only one report of possible adenine toxicity. Marginal acceptability of 24-hr 51Cr red cell recovery of packed red cells stored for 35 days in CPDA-1 has stimulated development and evaluation of an improved preservative (CPDA-2) which may extend blood storability beyond 35 days. A heightened awareness of the hematological consequences of prolonged storage has come with the extension of blood storage beyond 21 days. The concepts of component-specific preservation systems and optimal preservation systems have emerged as a result of experimentation on adenine preservatives. While the influence of adenine preservatives on American blood banking is yet to become manifest, the ultimte impact of adenine on blood preservation may be the development of novel systems which optimally preserve specific blood components at the option of the user.

The Significance of 2, 3–DPG in Red Blood Cell Transfusions

This review will begin by giving the highlights of the history and explain development of the basic science knowledge of hemoglobin chemistry, function, and physiology. The necessary involvement of red cell metabolism, as it pertains to the maintenance of 2,3-diphosphoglycerate (2,3-DPG) levels, both normally and under the perturbed and experimental conditions of blood storage, will be given as part of the basic science data. The clinical science and transfusion data will comprise the main critical aspects of the paper. Analysis and comment of over 20 studies will be given on the effects of animal and human transfusions with altered 2,3-DPG levels. Decreased survival and organ function have been demonstrated with transfusion of low 2,3-DPG red cells, with or without anemia, in the conditions of exercise, shock, hypotension, ischemia, cardiac surgery, hypoxia, sepsis, and acidosis. By critical analysis of these studies, recommendations on general and specific patient needs for red cell transfusions with normal or high 2,3-DPG levels are given.