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Parathyroid hormone secretion during exchange transfusion
Insights
Exchange transfusion with acid-citrate and dextrose (ACD) blood in infants with hemolytic disease causes a significant increase in parathyroid hormone (PTH) secretion, likely due to citrate-induced hypocalcemia. Heparinized blood transfusions did not produce this effect.
Area of Science:
- Neonatal Medicine
- Pediatric Hematology
- Biochemistry
Background:
- Infants with hemolytic disease often require exchange transfusions.
- Blood anticoagulants like acid-citrate and dextrose (ACD) and heparin are used during transfusions.
- The metabolic effects of these anticoagulants on infant physiology are not fully understood.
Purpose of the Study:
- To compare the effects of ACD and heparinized blood on plasma concentrations of calcium, phosphate, citrate, albumin, and parathyroid hormone (PTH) in infants undergoing exchange transfusion.
- To investigate the impact of citrate load on PTH secretion and mineral balance.
Main Methods:
- Plasma levels of calcium, phosphate, citrate, albumin, and PTH were measured in infants before, during, and after exchange transfusion.
- Infants received either ACD-anticoagulated or heparinized donor blood.
- Correlations between pretransfusion PTH, phosphate, and postnatal age were analyzed.
Main Results:
- ACD blood transfusion led to a twelvefold increase in plasma citrate but no immediate changes in infant plasma calcium, phosphate, or PTH.
- Heparinized blood transfusion did not alter plasma concentrations of measured substances.
- ACD blood transfusion resulted in a net loss of calcium, phosphate, and albumin, and a greater net loss of PTH compared to heparinized blood.
- A rise in plasma PTH was observed 3 hours post-ACD transfusion, but not post-heparin transfusion.
Conclusions:
- Transfusion with ACD blood increases parathyroid hormone (PTH) secretion in infants, likely due to citrate-induced hypocalcemia.
- Heparinized blood is a safer alternative regarding immediate metabolic disturbances and PTH secretion during exchange transfusion.
- Careful monitoring of mineral balance and PTH is recommended during exchange transfusions with ACD blood.
Abstract:
Plasma concentrations of calcium, phosphate, citrate, albumin, and parathyroid hormone (PTH) were measured during and after exchange transfusion of infants suffering from haemolytic disease using blood anticoagulated with acid-citrate and dextrose (ACD) or heparin. Pretransfusion plasma PTH and phosphate both correlated positively with postnatal age but not with each other. Transfusion with ACD blood caused a twelvefold rise in plasma citrate levels but no significant change in plasma calcium, phosphate, or PTH of the infant, despite the concentration of these substances being lower in the donor blood. The concentration of calcium, phosphate, and albumin was higher in heparinized than in ACD donor blood, and infants transfused with heparinized blood showed no change in the plasma concentration of any substance measured during transfusion. The addition of 50 mug glucagon to ACD donor blood had no effect on PTH secretion. 3 hours after transfusion there was a rise in the plasma PTH infants who had received ACD blood but not in those given heparinized blood. Transfusion with ACD blood caused a net loss of calcium, phosphate and albumin from the infant, whereas transfusion with heparin blood did not. Both types of transfusion caused a net loss of PTH but this was significantly greater in those given ACD blood. These results show that transfusion with ACD blood results in increased secretion of PTH, probably due to the fall in ionized calcium concentration caused by the citrate load.