Calcium Ion Activity During Rapid Exchange Transfusion with Citrated Blood

Perkins, Herbert A.; Snyder, Michele; Thacher, C.; Rolfs, Mary R.

doi:10.1111/j.1537-2995.1971.tb04402.x

Cited by 22 publications

(7 citation statements)

References 23 publications

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“…Additionally, citrate diffuses into the cells so that cytoplasmatic Ca 2+ is also bound as chelate [76]. When interpreting the present studies we must consider that a calculation of the free Ca 2+ from the total calcium is not valid, taken the concentration of albumin into account, and therefore, the calculations of the free Ca 2+ do not allow correct statements [71,[77][78][79].…”

Section: Physiology Of Calcium Balancementioning

confidence: 84%

Massive Transfusion and Its Influence on Oxygen Transport and Electrolyte Balance

Schmitt¹,

Lackes²

2000

Transfus Med Hemother

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During the process of storing erythrocyte-containing blood products, components of the preservatives and modifications of the erythrocyte function cause disorders of the electrolyte and acid-base balance as well as a deficiency of 2,3-diphosphoglycerate (2,3-DPG). Thereby transitory hyperkalemias may occur in the course of a massive transfusion, if the patient has a shock or another disturbance of the regulating mechanisms caused by diabetes mellitus or a treatment with β-blockers or ACE inhibitors. During the treatment with blood components, hypocalcemia and hypomagnesemia may develop after a dose of more than 12 fresh frozen plasms (FFP) per hour, if the metabolism of citrate, which binds bivalent cations as a chelate, is disturbed by hypothermia, shock or during the anhepatic stage of a liver transplantation. As a consequence, a low-output syndrome as well as tachyarrhythmias and torsades de pointes may develop. Whether the decrease of the 2,3-DPG level with the accompanying leftward shift of the oxyhemoglobin dissociation curve brings about a deficiency of the oxygen supply of the organs, has not yet been verified by experiment. The studies presented rather point at morphological changes of the erythrocytes due to the storage as the cause of the disturbances of capillary perfusion. For this reason patients with impending organ failure or marked disturbances of the coronary or cerebral perfusion should be transfused with packed red blood cells (RBCs) not older than 14 days.

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Section: Physiology Of Calcium Balancementioning

confidence: 84%

Massive Transfusion and Its Influence on Oxygen Transport and Electrolyte Balance

Schmitt¹,

Lackes²

2000

Transfus Med Hemother

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“…Experimentally in man and dogs, the effect of rapid infusion of citrate upon the cardiovascular system is to pro duce circulatory depression including hy potension, decreased pulse pressure and de creased cardiac output [2,8,16,17]. Decreases in ionized calcium of approximately 20% have been reported during cardiac surgery [5,11,16,18], and even greater depression (37-59% decrease) found during pediatric exchange transfusions [6,7]. the interval between infusions, the more rapidly the QT returned to normal.…”

Section: Discussionmentioning

confidence: 99%

Laboratory and Clinical Effects of the Infusion of ACD Solution During Plateletpheresis

Olson¹,

Cox²,

McCullough³

1977

Vox Sanguinis

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Transfusion of massive amounts of citrate anticoagulated blood during plateletpheresis with the intermittent flow centrifuge can produce symptoms and electrocardiographic changes suggestive of hypocalcemia. Following 15 procedures the ionized calcium decreased by an average of 32.4%, the average postpheresis serum citrate was 26.7 mg/dl and the QT interval was prolonged by 0.08 sec. Twelve plateletphereses performed with half-strength ACD solution caused an average decrease in ionized calcium of 16%, serum citrate levels of 12.5 mg/dl and QT prolongation of 0.04 sec. No donors experienced significant clinical symptoms with citrate infusion rates of less than 65 mg/kg/h. Solutions with citrate concentrations lower than ACD-A should be developed for use in plateletpheresis procedures involving citrate infusion rates greater than this.

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“…However, Case 3 probably did not require the calcium she received as the postexchange value was 0.3 mg/IOO ml higher than initially. Perkins et al 13 emphasized the lack of value of total serum calcium determinations in assessing the effects of transfusing ACD blood. They concluded that "the dangers of inducing clinically important deviations of ionized calcium levels in massive transfusion has been overemphasized" and that in massive transfusion of ACD blood, calcium supplementation is probaldy not necessary.…”

Section: Discussionmentioning

confidence: 99%

Rapid Plasma Exchange with the Continuous Flow Centrifuge

et al. 1973

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Four cases are described in which rapid exchange of large volumes of plasma (3.8–7.1 liters) was performed with the continuous flow centrifuge and unmodified fresh frozen plasma. Emphasis of this report is on the procedures used and the laboratory evaluation of the effects of plasma exchange. The patients received from 1,000 to 4,900 units of heparin and 628 to 1,299 ml of ACD during the procedure but no hemorrhagic complications were encountered. Supplementary calcium was administered to two patients and no clinical complications caused by hypocalcemia were observed. Serum potassium, chloride and bicarbonate were slightly decreased following plasma exchange, and hypernatremia did not occur. With careful evaluation and monitoring of patients, rapid plasma exchange with the continuous flow centrifuge appears to be practical and safe for the patient.

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Calcium Ion Activity During Rapid Exchange Transfusion with Citrated Blood

Cited by 22 publications

References 23 publications

Massive Transfusion and Its Influence on Oxygen Transport and Electrolyte Balance

Massive Transfusion and Its Influence on Oxygen Transport and Electrolyte Balance

Laboratory and Clinical Effects of the Infusion of ACD Solution During Plateletpheresis

Rapid Plasma Exchange with the Continuous Flow Centrifuge

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