Package insert / product label
Generic name: citric acid monohydrate, dextrose monohydrate, and trisodium citrate dihydrate
Dosage form: injection, solution
On This Page
- Indications and Usage
- Dosage and Administration
- Dosage Forms and Strengths
- Contraindications
- Warnings and Precautions
- Adverse Reactions/Side Effects
- Use In Specific Populations
- Description
- Clinical Pharmacology
- How Supplied/Storage and Handling
Expand
Indications and Usage for ACD A
ANTICOAGULANT CITRATE DEXTROSE SOLUTION USP (ACD) SOLUTION A is an anticoagulant for blood collection for use only with apheresis devices. [See Dosage and Administration (2).]
ACD A Dosage and Administration
General Dosing Information
ANTICOAGULANT CITRATE DEXTROSE SOLUTION USP (ACD) SOLUTION A is added to tubing sets during apheresis procedures. The solution is connected to the tubing set in an apheresis collection. The recommended dose is determined by the apheresis device and metered into the tubing set by the apheresis device. It is not intended for direct intravenous infusion.
For instructions on the use of the solution with the apheresis device and tubing set, see the device operator's manual.
Administration
- Ensure solution is the ANTICOAGULANT CITRATE DEXTROSE SOLUTION USP (ACD) SOLUTION A and is within the expiration date.
- Inspect the bag. Do not use if the container is damaged, leaking or if there is any visible sign of deterioration.
- Use only if solution is clear and free of particulate matter.
- Protect from sharp objects.
Directions for Connecting the ANTICOAGULANT CITRATE DEXTROSE SOLUTION USP (ACD) SOLUTION A bag to the apheresis device.
At the prompt to connect anticoagulant to the apheresis device tubing set:
- Remove the overwrap by pulling down at notch, and remove the ANTICOAGULANT CITRATE DEXTROSE SOLUTION USP (ACD) SOLUTION A bag.
- Before use, perform the following checks [See Warnings and Precautions (5).]:
- Check for leaks by gently squeezing the bag. If leaks are found, discard the bag.
- Ensure that the solution is the ANTICOAGULANT CITRATE DEXTROSE SOLUTION USP (ACD) SOLUTION A and is within the expiration date.
- Inspect the solution in adequate light. Bags showing cloudiness, haze, or particulate matter should not be used.
- Remove the protective cap from the port on the bag.
- Connect the bag to the apheresis device tubing set using aseptic technique and hang the solution.
- Break the frangible connector. When you break frangible connectors, bend them in both directions to ensure that you break them completely. Failure to do so may result in restricted flow.
- Proceed according to the apheresis device operator's manual.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.
Dosage Forms and Strengths
500 mL or 750 mL ANTICOAGULANT CITRATE DEXTROSE SOLUTION USP (ACD) SOLUTION A is a sterile solution in a polyolefin bag. Each 100 mL contains: (%w/v) Citric Acid, Monohydrate 0.8 g; Dextrose Monohydrate 2.45 g; Sodium Citrate Dihydrate 2.2 g; and Water for Injection.
Contraindications
DO NOT INFUSE ANTICOAGULANT CITRATE DEXTROSE SOLUTION USP (ACD) SOLUTION A DIRECTLY TO THE PATIENTS.
Warnings and Precautions
- Verify that the ANTICOAGULANT CITRATE DEXTROSE SOLUTION USP (ACD) SOLUTION A has been securely attached to the Anticoagulant (AC) line on the system tubing set. Use aseptic technique throughout all procedures to ensure donor safety and quality.
- Do not reuse. Discard unused or partially used solution bags.
Adverse Reactions
Citrate reactions or toxicity may occur with the infusion and return of blood containing citrate anticoagulant. The recipient of the blood containing citrate should be monitored for the signs and symptoms of citrate toxicity. The signs and symptoms of citrate toxicity begin with paresthesia, a "tingling" sensation around the mouth or in the extremities, followed by severe reactions that are characterized by hypotension and possible cardiac arrhythmia. Citrate toxicity may occur more frequently in patients who are hypothermic, have impaired liver or renal function, or have low calcium levels because of an underlying disease.
USE IN SPECIFIC POPULATIONS
ANTICOAGULANT CITRATE DEXTROSE SOLUTION USP (ACD) SOLUTION A has not been adequately studied in controlled clinical trials with specific populations.
ACD A Description
ANTICOAGULANT CITRATE DEXTROSE SOLUTION USP (ACD) SOLUTION A is designed to be metered by an apheresis device in apheresis procedures, to prevent platelet activation and coagulation as blood moves throughout the extracorporeal unit (tubing set) in an apheresis procedure.
The solution is sterile and non-pyrogenic, and it contains no bacteriostatic or antimicrobial agents.
The formulas of the active ingredients are provided in Table 1.
| Ingredients | Molecular Formula | Molecular Weight |
|---|---|---|
| (%w/v) Citric Acid, Monohydrate | C6H8O7 | 192.12 |
| Dextrose Monohydrate | C6H12O6 ∙ H2O | 198.17 |
| Sodium Citrate Dihydrate | C6H9Na3O9 | 294.10 |
| Water for Injection | H2O | 18.00 |
Each 100 mL of ANTICOAGULANT CITRATE DEXTROSE SOLUTION USP (ACD) SOLUTION A contains: (%w/v) Citric Acid, Monohydrate 0.8 g; Dextrose Monohydrate 2.45 g; Sodium Citrate Dihydrate 2.2 g; and Water for Injection.
The polyolefin bag is not made with natural rubber latex or PVC.
The bag is made from a multilayered film. It contains materials that have been tested to demonstrate the suitability of the container for storing pharmaceutical solutions. The solution contact layer is an elasticized polyolefin. The bag is nontoxic and biologically inert. The bag-solution unit is a closed system and is not dependent upon entry of external air during administration. The bag is overwrapped to provide protection from the physical environment and to provide an additional moisture barrier when necessary.
ACD A - Clinical Pharmacology
Mechanism of Action
ANTICOAGULANT CITRATE DEXTROSE SOLUTION USP (ACD) SOLUTION A acts as an extracorporeal anticoagulant by binding the free calcium in the blood. Calcium is a necessary co-factor to several steps in the clotting cascade. The following ingredients are key components of the solution:
- Citric acid for pH regulation
- Sodium Citrate anticoagulates
- Dextrose for isotonicity
This solution has no pharmacological effect.
How Supplied/Storage and Handling
ANTICOAGULANT CITRATE DEXTROSE SOLUTION USP (ACD) SOLUTION A is a clear solution supplied in sterile and non-pyrogenic polyolefin bags. The 750 mL bags are packaged 12 bags per case. The 500 mL bags are packaged 18 bags per case.
| SIZE | CATALOG NUMBER | NDC NUMBER |
|---|---|---|
| 500 mL | 40815 | 14537-815-50 |
| 750 mL | 40817 | 14537-817-75 |
STORAGE
Store up to 25 °C [See USP Controlled Room Temperature].
Avoid excessive heat. Protect from freezing.
Issued: (August 2017)
Manufactured by
Terumo BCT, Inc.
Lakewood, CO 80215
PRINCIPAL DISPLAY PANEL - 750 mL Bag Label
Anticoagulant Citrate Dextrose
Solution USP (ACD) Solution A
Catalog # 40817
Polyolefin Bag
750 mL
NDC 14537-817-75
Sterile. Non-pyrogenic. Sterilized with Steam.
Do not use unless the solution is clear and the
container is intact.
Rx Only.
Single use container.
Read the package insert before application.
For use only with apheresis devices. See apheresis
device operator's manual for complete instructions.
Caution: Not for direct intravenous infusion.
Recommended storage:
Store up to 25 °C. (See USP Controlled Room
Temperature).
Avoid excessive heat.
Protect from freezing.
Each 100 mL contains:
Dextrose Monohydrate USP
2.45 g
Sodium Citrate Dihydrate USP
2.20 g
Citric Acid Monohydrate USP
0.80 g
In Water for Injection USP
Manufactured by Terumo BCT, Inc.
10811 W. Collins Ave., Lakewood CO 80215, USA
777967-057
TERUMOBCT
Lot
Expiry Date
PRINCIPAL DISPLAY PANEL - 500 mL Bag Label
Anticoagulant Citrate Dextrose
Solution USP (ACD) Solution A
Catalog # 40815
Polyolefin Bag
500 mL
NDC 14537-815-50
Sterile. Non-pyrogenic. Sterilized with Steam.
Do not use unless the solution is clear and the
container is intact.
Rx Only.
Single use container.
Read the package insert before application.
For use only with apheresis devices. See apheresis
device operator's manual for complete instructions.
Caution: Not for direct intravenous infusion.
Recommended storage:
Store up to 25 °C. (See USP Controlled Room
Temperature).
Avoid excessive heat.
Protect from freezing.
Each 100 mL contains:
Dextrose Monohydrate USP
2.45 g
Sodium Citrate Dihydrate USP
2.20 g
Citric Acid Monohydrate USP
0.80 g
In Water for Injection USP
Manufactured by Terumo BCT, Inc.
10811 W. Collins Ave., Lakewood CO 80215, USA
777967-540
TERUMOBCT
Lot
Expiry Date
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Labeler - Terumo BCT, Ltd. (233649834)
| Establishment | |||
| Name | Address | ID/FEI | Operations |
| Terumo BCT, Ltd. | 233649834 | MANUFACTURE(14537-817, 14537-815), STERILIZE(14537-817, 14537-815), ANALYSIS(14537-817, 14537-815), LABEL(14537-817, 14537-815) | |
Terumo BCT, Ltd.
Medical Disclaimer
FAQs
What is ACD solution used for? ›
Acid Citrate Dextrose (ACD) Solution A, also known as Anticoagulant Citrate Dextrose Solution is used as an anti-coagulant for whole blood and erythrocyte survival, routinely used for blood storage. The ideal red blood cells shelf life is 21 days when stored in ACD solution.
How do you make ACD solution? ›- Collect a unit of blood into ACD or CPD anticoagulant. ...
- Add 1 ml of 100 g/l EDTA solution (100 g/l of K2 EDTA in the Alsever solution). ...
- Add 200 ml of glutaraldehyde fixative (0.25% in 0.15 mol/l phosphate buffer, pH 7.4). ...
- Centrifuge for 30 min at 3500 g.
ACD A Description
Each 100 mL of ANTICOAGULANT CITRATE DEXTROSE SOLUTION USP (ACD) SOLUTION A contains: (%w/v) Citric Acid, Monohydrate 0.8 g; Dextrose Monohydrate 2.45 g; Sodium Citrate Dihydrate 2.2 g; and Water for Injection.
Side effects due to ACD administration include symptoms of hypocalcemia, which may include perioral tingling; hypotension; or, very rarely, tetany.
What is the price of ACD solution? ›Prp BD Vacutainer Acd Solution A Blood Collection Tube, For Clinical, Size: 16x100 MM at Rs 35/piece in Delhi.
What test is ACD? ›There is no specific single test for ACD. The four most commonly used screening tests are serum iron, TIBC (transferrin), percent transferrin saturation, and serum ferritin. ACD shows a normal or decreased serum iron, decreased TIBC, transferring saturation greater than 10%, and increased serum transferrin.
How long can ACD store blood? ›When RBC ATP decreased to the level of critical ATP, the time of preservation was considered as shelf life. The results showed that at temperatures from 10 to 33 degrees C, the shelf life of CPDA whole blood ranges from 2.5 days to 18 days, while shelf life of ACD whole blood ranges from 1 day to 13 days.
What is the difference between ACD solution A and B? ›ACD Solution A (ACD-A) consists of Trisodium Citrate, 22.0 g/L, Citric Acid, 8.0 g/L, and Dextrose, 24.5 g/L. ACD Solution B (ACD-B) consists of Trisodium Citrate, 13.2 g/L, Citric Acid, 4.8 g/L, and Dextrose, 14.7 g/L.
What is the mode of action of ACD? ›Clinical Pharmacology
ACD-A acts as an anticoagulant by the action of the citrate ion chelating free ionized calcium, thus making calcium unavailable to the coagulation system.
ACD-A Anticoagulant Citrate Dextrose Solution, Solution A, USP (2.13% free citrate ion), is a sterile, non-pyrogenic solution. ACD-A is the only anticoagulant product approved by the United States Food & Drug Administration (FDA) for the use in Autologous PRP Systems for the preparation of Platelet-Rich Plasma (PRP).
What tube is used for ACD? ›
Yellow-top tube (ACD)
This tube contains ACD, which is used for the collection of whole blood for special tests. NOTE: After the tube has been filled with blood, immediately invert the tube 8-10 times to mix and ensure adequate anticoagulation of the specimen.
Acid-citrate-dextrose or acid-citrate-dextrose solution, also known as anticoagulant-citrate-dextrose or anticoagulant-citrate-dextrose solution (and often styled without the hyphens between the coordinate terms, thus acid citrate dextrose or ACD) is any solution of citric acid, sodium citrate, and dextrose in water.
What are three common side effects? ›...
Unwanted or Unexpected Drug Reactions
- start taking a new drug or dietary supplement (for example, vitamins)
- stop taking a drug that you've been on for a while, or.
- increase or decrease the dose (amount) of a drug that you take.
For anticoagulation during cytapheresis, citrate solutions, commonly ACD-A, are used, at a recommended anticoagulant-to-whole blood ratio of 1:11 to 1:12.
What does sodium citrate do to blood? ›Background: Sodium citrate has been used as an anticoagulant to stabilize blood and blood products for over 100 years, presumably by sequestering Ca(++) ions in vitro. Anticoagulation of blood without chelation can be achieved by inhibition of the contact pathway by corn trypsin inhibitor (CTI).
What is ACD phlebotomy solution? ›A solution called acid citrate dextrose is added to the blood to stop clotting during this process: citrate, in particular, has the effect of lowering blood calcium levels to a point where the blood cannot clot in the machine. New Scientist. abbreviation ACD.
What is the pH of ACD? ›Blood preserved in acid-citrate-dextrose solutions (A.C.D. blood) has a pH 6·0 to 7·1 (Bunker 1966, Gibson et al. 1956, Rapoport 1947).
What diseases cause low iron? ›Certain diseases — such as cancer, HIV / AIDS , rheumatoid arthritis, kidney disease, Crohn's disease and other acute or chronic inflammatory diseases — can interfere with the production of red blood cells. Aplastic anemia. This rare, life-threatening anemia occurs when your body doesn't produce enough red blood cells.
How can you tell the difference between IDA and ACD? ›The major difference between ACD and IDA is that in IDA there is an absolute lack (serum ferritin below 30 ng/mL) [1] of iron, while the pathogenesis of ACD is multifactorial and the iron though available is not accessed by the young erythroid precursors.
How many days does it take for blood to expire? ›Red cells are stored in refrigerators at 6ºC for up to 42 days. Platelets are stored at room temperature in agitators for up to five days. Plasma and cryo are frozen and stored in freezers for up to one year.
Does blood plasma expire? ›
Frozen Plasma - The shelf life is 1 year from the date of collection. Thawed Plasma - The shelf life of thawed plasma is either 24 hours or 5 days, depending on the plasma product. The expiration date is located on the unit(s).
Does stored blood expire? ›Each unit of whole blood is separated into several components. Red blood cells may be stored under refrigeration for a maximum of 42 days. Platelets are stored at room temperature and may be kept for a maximum of five to seven days. Fresh frozen plasma is kept in a stored frozen state for up to one year.
Is ACD legal? ›An ACD is legally enforceable in NSW. By not complying with a valid ACD, a health practitioner may be breaching his or her duty of care to their patient and could be sued for negligence.
What is the full form of ACD? ›The full form of ACD is Automatic Call Distributor. It is a device capable of detecting, handling and directing large amounts of incoming calls.
What is the difference between ACD and non ACD? ›ACD calls are defined as handled when an agent picks up the call. ACD calls are calls dialed to an ICD route point number. A non-ACD call is any call that is not dialed to an ICD route point number, for example, an internal call between agents or an outbound call.
What prescription drugs have the worst side effects? ›- Anti-anxiety medications and sedatives. A variety of prescription drugs to treat anxiety or induce sleep are available, including benzodiazepines, barbiturates, zolpidem, and eszopiclone. ...
- Stimulants. ...
- Opioids. ...
- Anabolic steroids.
Known teratogenic prescription medications include warfarin, divalproex (Depakote), Paxil, topiramate (Topamax), methotrexate (Rheumatrex), angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, nonsteroidal anti-inflammatory drugs, oral contraceptives, statins, and tetracyclines.
What drugs have bad side effects? ›- Antibiotics like sulfa antibiotics, penicillins, and quinolones.
- Seizure medications, such as carbamazepine (Tegretol, Tegretol XR), phenytoin (Dilantin, Phenytek), and lamotrigine (Lamictal)
- Piroxicam (Feldene)
- Allopurinol (Zyloprim)
- Oseltamivir (Tamiflu)
The anticoagulant volume may be computed by using this formula: C (1.85 X10–3 ) (100 – HCT ) V, where C is the volume of sodium citrate in mL, V is volume of whole blood-sodium citrate solution in mL, and HCT is the hematocrit in %.
How much percentage (%) of the total blood volume is plasma? ›Our red blood cells, white blood cells and platelets, make up about 45% of the volume of our blood. The remaining 55% is liquid plasma.
What is the ratio of anticoagulant to whole blood in a unit of whole blood? ›
Abstract. Background: Routinely, 450 mL of blood is collected into 63 mL of CPDA-1, for a final anticoagulant:blood ratio of approximately 1:7 in a whole-blood autologous unit.
Who shouldnt take sodium citrate? ›Before taking this medicine
You should not use citric acid and sodium citrate if you have: severe kidney disease; decreased urination (or if you are unable to urinate); severe heart damage (such as from a heart attack);
Sodium citrate and citric acid combine in an oral solution to prevent kidney stones and metabolic acidosis. This solution works by making your blood and pee less acidic. You can mix this solution with 6 ounces of water before drinking it as directed.
Does sodium citrate raise blood pressure? ›As opposed to sodium chloride, however, sodium citrate failed to raise resting blood pressure.
What is ACD used for in phlebotomy? ›Yellow-top tube (ACD)
This tube contains ACD, which is used for the collection of whole blood for special tests. NOTE: After the tube has been filled with blood, immediately invert the tube 8-10 times to mix and ensure adequate anticoagulation of the specimen.
It is a calcium-chelating agent and prevents coagulation by interfering with calcium-dependent steps in the coagulation cascade. Citrate retards glycolysis.
How long can blood stored in ACD? ›The results showed that at temperatures from 10 to 33 degrees C, the shelf life of CPDA whole blood ranges from 2.5 days to 18 days, while shelf life of ACD whole blood ranges from 1 day to 13 days.
What color tube is used for ACD? ›Yellow-top tube: Contains acid citrate dextrose (ACD) solution. Use: ACD whole blood. Send whole blood in a yellow-top tube.
In what tube will you find ACD additive? ›Yellow top tube with ACD (acid citrate dextrose) Solution A or B: used for whole blood determinations including flow cytometry and tissue typing assays.
What does citric acid do to blood? ›Conclusions: Citric acid infusions determine acidification and anticoagulation of blood similar to lactic acid and sodium citrate, respectively.
What does citric acid do to your cells? ›
Citric acid helps with energy metabolism, the absorption of minerals, and the prevention or treatment of kidney stones.
Why do they put citric acid in everything? ›It is most frequently added in order to preserve food, but can also be used to create a sour or tart flavor. Unlike most commercial preservatives that actually kill bacteria, citric acid is a more natural means to extend a product's shelf-life as it simply lowers the pH to a point where bacteria can't thrive.