Continuous infusion of calcium gluconate in 5% albumin is safe and prevents most hypocalcemic reactions during therapeutic plasma exchange

Kankirawatana, Suthida; Huang, Shu T.; Marques, Marisa B.

doi:10.1002/jca.20142

Cited by 31 publications

(24 citation statements)

References 16 publications

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“…Strategies for minimizing hypocalcemic symptoms include reducing the citrate delivery rate (0.25 to 1.8 mg/kg/min), and prophylactic calcium administration. Calcium may be added to albumin preinfusion, or administered intravenously as a continuous infusion or a schedule of boluses [21,34,35]. Prophylactic intravenous calcium administration has been associated with a significant reduction in hypocalcemic toxicity (Figure 3).…”

Section: Clinical Adverse Events During Therapeutic Apheresismentioning

confidence: 99%

Introduction and overview of therapeutic apheresis

Okafor

Ward

Mokrzycki

et al. 2010

J of Clinical Apheresis

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Section: Clinical Adverse Events During Therapeutic Apheresismentioning

confidence: 99%

Introduction and overview of therapeutic apheresis

Okafor

Ward

Mokrzycki

et al. 2010

J of Clinical Apheresis

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“…4a). CaGl is globally approved for treatment of hypocalcaemia [37], [38] while PBS is also widely used in humans; typically when an isotonic and non-toxic solution is needed [39]–[41]. To assess dose response, we analyzed serial dilutions of heated CaGl and found that intermediate doses gave the best results (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…However, the calcium phosphate technique widely used in the laboratory cannot be applied to humans. Therefore, we sought to extend the approach to calcium and phosphate substrates accepted for human use: CaGl and PBS [37]–[41].…”

Section: Discussionmentioning

confidence: 99%

Calcium Gluconate in Phosphate Buffered Saline Increases Gene Delivery with Adenovirus Type 5

et al. 2010

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BackgroundAdenoviruses are attractive vectors for gene therapy because of their stability in vivo and the possibility of production at high titers. Despite exciting preclinical data with various approaches, there are only a few examples of clear efficacy in clinical trials. Effective gene delivery to target cells remains the key variable determining efficacy and thus enhanced transduction methods are important.Methods/ResultsWe found that heated serum could enhance adenovirus 5 mediated gene delivery up to twentyfold. A new protein-level interaction was found between fiber knob and serum transthyretin, but this was not responsible for the observed effect. Instead, we found that heating caused the calcium and phosphate present in the serum mix to precipitate, and this was responsible for enhanced gene delivery. This finding could have relevance for designing preclinical experiments with adenoviruses, since calcium and phosphate are present in many solutions. To translate this into an approach potentially testable in patients, we used calcium gluconate in phosphate buffered saline, both of which are clinically approved, to increase adenoviral gene transfer up to 300-fold in vitro. Gene transfer was increased with or without heating and in a manner independent from the coxsackie-adenovirus receptor. In vivo, in mouse studies, gene delivery was increased 2-, 110-, 12- and 13-fold to tumors, lungs, heart and liver and did not result in increased pro-inflammatory cytokine induction. Antitumor efficacy of a replication competent virus was also increased significantly.ConclusionIn summary, adenoviral gene transfer and antitumor efficacy can be enhanced by calcium gluconate in phosphate buffered saline.

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“…Especially in patients with decreased liver function where citrate is metabolized, profound hypocalcemia due to citrate metabolism impairment (20,21) may be of concern. Although no definitive protocol against hypocalcemia exists, calcium supplementation is reportedly effective (22,23). Hemodialysis that is connected in tandem to the circuit of plasma exchange can eliminate sodium citrate and prevent adverse electrolyte disorders related to FFP (24).…”

Section: Choice Of Modality With Consideration Of Complicationsmentioning

confidence: 99%

Theoretical Basis of Pathogenic Substance Removal During Plasmapheresis

Hanafusa

2011

Ther Apher Dial

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This article explains theoretical considerations of prescribing plasmapheresis. It is important to consider several factors in prescribing apheresis: (i) the properties of pathogenic substances, such as molecular weight, distribution volume, compartment, and production rate; (ii) therapeutic conditions such as the processed plasma volume and the frequency of processing; and (iii) the patient's condition, such as active bleeding or infection. A substance's molecular weight determines whether it can be removed using a particular membrane filter. Substances with a small distribution volume and low production rate are removed.Consequently, the processed volume per total plasma volume is related to the single-session efficacy. Nevertheless, even frequent therapy cannot reduce the total pool of a substance within the body if movement from outside the vessels is slow. Active bleeding or infection might be exacerbated by modalities other than simple plasma exchange with fresh plasma supplementation because such therapies cannot replenish substances other than albumin. Key Words: Compartment, Distribution volume, Molecular weight, Plasmapheresis, Production rate.Apheresis is a group of therapies by which blood is drawn from the body and then let back into the body after removing pathogenic substances from the blood. The scope of apheresis is quite broad. Table 1 presents those diseases for which plasmapheresis expenses are reimbursed by the Japanese government.Hemodialysis, especially for end-stage renal disease, is used uniformly for the removal of small solutes; however, apheresis is aimed at the removal of many various substances because the scope is wide, as described above. Moreover, production rates vary among patients because the target diseases often include acute-phase morbidity; therefore, the therapy conditions should be individualized.When examining and prescribing the therapeutic conditions, the following factors must be considered: (i) the properties of the substances to be removed; (ii) the therapeutic conditions; and (iii) the patients' condition. These factors of three domains are closely related, and, in fact, they should be considered together while prescribing apheresis. This review will explain those factors that influence the efficiency of apheresis therapy. PROPERTIES AND PRESCRIPTIONS OF SUBSTANCES TO BE REMOVEDThe properties of the substances to be removed are important for the prescription and even the selection of therapy. Based upon these properties, we determine the modality, dose, and frequency of the therapy. Moreover, considering such properties, we can prescribe the conditions of apheresis in patients with new pathogenic substances and can predict the course of elimination.The properties determining the effectiveness of removal are: (i) molecular weight and distribution volume related to the efficiency of single therapy; and (ii) compartments and diffusion velocity across the compartments, and production rates related to the frequency and quantity of sessions.

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Continuous infusion of calcium gluconate in 5% albumin is safe and prevents most hypocalcemic reactions during therapeutic plasma exchange

Cited by 31 publications

References 16 publications

Introduction and overview of therapeutic apheresis

Introduction and overview of therapeutic apheresis

Calcium Gluconate in Phosphate Buffered Saline Increases Gene Delivery with Adenovirus Type 5

Theoretical Basis of Pathogenic Substance Removal During Plasmapheresis

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