Treatment for the decline of ionized calcium levels during peripheral blood progenitor cell harvesting

Kishimoto, Mitsumasa; Ohto, Hitoshi; Shikama, Yayoi; Kikuta, Atsushi; Kimijima, Izo; Takenoshita, Seiichi

doi:10.1046/j.1537-2995.2002.00205.x

Cited by 39 publications

(44 citation statements)

References 32 publications

(28 reference statements)

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“…However, WBCT did not significantly change at 3 and 4 mmol/kg/hr of citrate despite the appearance of clinical signs that are considered to be related to ionized hypocalcemia (Kishimoto et al, 2002;Fukuda et al, 2002). In addition, electrocardiographic changes such as prolonged Q-T intervals and T wave alternans or depressions in arterial pressure and systemic vascular resistance are induced at above similar blood Ca 2+ levels in studies with pigs, dogs or humans (Dzik and Kirkley, 1988;Scheidegger et al, 1980;Liu et al, 1992;Olson et al, 1977;Howland et al, 1977;Bunker et al, 1962;Drop and Scheidegger, 1979).…”

Section: Discussionmentioning

confidence: 97%

Effect of Whole Blood Clotting Time in Rats With Ionized Hypocalcemia Induced by Rapid Intravenous Citrate Infusion

et al. 2006

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-Although the toxic effects of citrate including hemodynamic and cardiovascular changes result from a decrease in ionized calcium levels in serum due to chelating action, these effects of citrate on blood coagulation have not yet been fully clarified. The present study examines whether serum citrate and ionized calcium levels affect whole blood clotting time in rats using the test tube method in which citrate is administered by rapid intravenous infusion. Citrate was infused via the tail vein into 10 rats at 3, 4 or 5 mmol/kg/hr for 1 hr, and then whole blood clotting time, serum citrate and ionized calcium levels were determined. Whole blood clotting time did not significantly change at citrate infusion rates of 3 and 4 mmol/kg/hr. However, at 5 mmol/kg/hr, whole blood clotting time was significantly prolonged by a factor of 2.1 relative to the untreated group, when the serum citrate level was 10.03 ± 1.39 mmol/l (59.0-fold higher than that in the untreated group) and the serum-ionized calcium level was 0.29 ± 0.02 mmol/ l (0.2-fold lower than that in the untreated group). These results suggest that whole blood clotting time is significantly prolonged in rats with severe ionized hypocalcemia.

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Section: Discussionmentioning

confidence: 97%

Effect of Whole Blood Clotting Time in Rats With Ionized Hypocalcemia Induced by Rapid Intravenous Citrate Infusion

et al. 2006

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“…In hematopoietic progenitor cell (HPC) collections, the continuous infusion of either calcium gluconate or calcium chloride has been found to prevent hypocalcemic symptom development [14,15] with calcium chloride maintaining higher ionized calcium levels [15]. In a comparison with a continuous infusion of calcium gluconate, prophylactically at the start of HPC collection, or at the time of symptom development, continuous infusion maintained higher calcium levels with insignificant changes seen in the other two modes of administration [16].…”

Section: Citrate Toxicity Hypocalcemiamentioning

confidence: 99%

Complications of donor apheresis

Winters

2006

J. Clin. Apheresis

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A decreasing blood donor pool in the presence of increasing blood transfusion demands has resulted in the need to maximally utilize each blood donor. This has led to a trend in the increasing use of automated blood collections. While apheresis donation shares many reactions and injuries with whole blood donation, because of the differences, unique complications also exist. Overall, evidence in the literature suggests that the frequency of reactions to apheresis donation is less than that seen in whole blood donation, though the risk of reactions requiring hospitalization is substantially greater. The most common apheresis-specific reaction is hypocalcemia due to citrate anticoagulation, which, while usually mild, has the potential for severely injuring the donor. Other reactions to apheresis donation are uncommon (e.g., hypotension) or rare (e.g., air embolism). More worrisome, and in need of additional study, are the long-term effects of apheresis donation. Recent evidence suggests that repeated apheresis platelet donations may adversely effect thrombopoiesis as well as bone mineralization. Granulocyte donation has also been implicated in unexpected long-term consequences.

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“…Hypocalcemia is a toxicity of citrate administration 18,19 and is thought to be more common in pediatric patients receiving citrate than adults. 12,20 Hypocalcemia was screened for in 77% of the donors and measured in 4% (three with ionized Ca 2 þ o0.8 mmol/l (CTC grade 4), one between 0.8 and 0.9 mmol/l (CTC grade 3), and three between 0.9 and 1.0 mmol/l (CTC grade 2)).…”

Section: Complications Of Growth Factor Administration and Apheresismentioning

confidence: 99%

Safety and efficacy of allogeneic PBSC collection in normal pediatric donors: The Pediatric Blood and Marrow Transplant Consortium Experience (PBMTC) 1996–2003

Pulsipher

Levine

Hayashi

et al. 2004

Bone Marrow Transplant

101

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Summary:The use of peripheral blood stem cells (PBSC) for allogeneic transplants in adults has greatly increased. This trend is reflected in pediatrics, where healthy children increasingly are donating PBSC or donor lymphocyte infusion (DLI) via apheresis for use by ill siblings. There is a potential concern that the risks of PBSC collection may differ for pediatric donors. However, no large studies have assessed safety issues in this population. To address this need, we reviewed 218 (213 PBSC, five DLI) collections in 201 normal pediatric donors (8 months to 17 years, median 11.8 years) at 22 institutions in the Pediatric Blood and Marrow Transplant Consortium. Donors received a median of 4 days of growth factor, and mean collection yield was 9.1 Â 10 6 CD34 þ cells/kg recipient weight. Younger age, days of apheresis, and male gender predicted increased yield of CD34 þ cells/kg donor weight. Growth factor-induced pain was mild and reported in less than 15% of patients. Most donors o20 kg (23/25, 92%) required PRBC priming of the apheresis machine. This experience with over 200 collections demonstrates that PBSC collection is safe in normal pediatric donors and desired CD34 cell yields are easily achieved. Younger children utilize more medical resources and children o20 kg usually require a single blood product exposure.

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Treatment for the decline of ionized calcium levels during peripheral blood progenitor cell harvesting

Abstract: An isotonic sports drink containing calcium has a quick stabilizing and a longer maintenance effect on ICa. Thus, we recommend the intake of an isotonic sports drink containing calcium as the easiest and best method for preventing hypocalcemia during apheresis.

Cited by 39 publications

References 32 publications

Effect of Whole Blood Clotting Time in Rats With Ionized Hypocalcemia Induced by Rapid Intravenous Citrate Infusion

Effect of Whole Blood Clotting Time in Rats With Ionized Hypocalcemia Induced by Rapid Intravenous Citrate Infusion

Complications of donor apheresis

Safety and efficacy of allogeneic PBSC collection in normal pediatric donors: The Pediatric Blood and Marrow Transplant Consortium Experience (PBMTC) 1996–2003

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