Comparative Effects of ACD, CPD, and CPDA-1 on Haematological and Enzyme Parameters in Stored Blood

Abstract

Background: Stored whole blood undergoes progressive haematological and enzymatic changes that may vary according to the anticoagulant-preservative solution used. Aims: This study evaluated the impact of anticoagulant type (ACD, CPD, and CPDA-1) and ABO blood group on haematological parameters and red cell enzyme activities during a 30-day storage period at 4°C. Study Design: This was an exploratory, prospective, observational, and experimental study designed to monitor blood component quality over a period of 30 days. Place and Duration of Study: Department of Medical Laboratory Science, Igbinedion University Teaching Hospital, Okada, from March 2026 to May 2026. Methodology: This exploratory pilot study was conducted at Igbinedion University Teaching Hospital, Okada. Twelve healthy voluntary donors [three per ABO group] each donated one whole-blood unit [450 mL]. Units were stratified by ABO group and randomly allocated to ACD [n = 4], CPD [n = 4], or CPDA-1 [n = 4; one per ABO group per anticoagulant], thereby ensuring the use of independent donors. Units were stored at 4°C and sampled at 11 time points [Days 1, 3, 6, 9, 12, 15, 18, 21, 24, 27, and 30]. Full blood counts were performed using a Sysmex KX-21N analyser with daily calibration and e-Check controls. G6PD and GR were measured by ELISA [Cloud-Clone Corp.; Catalogue Nos. SEB723Hu and SEB314Hu; detection ranges, 0.312–20 ng/mL and 0.156–10 ng/mL; sensitivities, 0.112 and 0.056 ng/mL; intra-assay CV < 10%]. Data were analysed using the Friedman test, the Kruskal-Wallis test with Dunn-Bonferroni correction, and eta-squared [η²] effect sizes with 95% confidence intervals. Results: All anticoagulants showed significant time-dependent declines in Hb, Hct, RBC count, and G6PD activity (p < 0.001). By Day 30, G6PD activity had decreased by 6.9–9.0%, whereas GR activity had decreased by 0.5–1.2%. Between-anticoagulant comparisons revealed significant differences in RBC count (p = 0.036), PLT count (p = 0.049), and GR activity (p = 0.037). CPDA-1 showed the least decline in Hb (-23.7%), Hct (-15.3%), PLT count (+11.5%), and GR (98.34 ± 1.32 U/g Hb), although the differences were not statistically significant (p = 0.105). CPD best preserved the RBC count (-23.1%) and G6PD activity (-6.9%). ABO blood group had no significant effect on Day 30 (p > 0.23). Conclusion: In this exploratory pilot study with a small sample size [n = 12; four per anticoagulant group], CPDA-1 tended to preserve some haematological indices better than ACD and CPD; however, most Day 30 differences were not statistically significant after adjustment for multiple comparisons. Larger confirmatory studies are required before protocol changes can be recommended. ABO blood group did not appear to influence storage quality. The small sample size limits statistical power and generalisability; therefore, the findings are hypothesis-generating.