Collection of blood in "excess" ACD leads to a loss of red cell viability when the blood is transfused back into the donor, even without any appreciable storage period. The mechanism of this loss of viability is not clear. The loss is accentuated by incubation at 37 C.; it is not affected by varying the dextrose concentration of the ACD; it cannot entirely be attributed to change in pH of the final suspension medium; and it is not related to the degree of swelling of the red cells. The loss of viability can completely be corrected by the addition of small amounts of chloride to the ACD.
This effect is presumably the same as the "lesion of collection" described by Gibson et al. in relation to viability studies after 28 days of storage.4