Hypocalcaemia during surgery for ruptured De Bakey type III thoracoabdominal aneurysm. A case report

A case of a leaking De Bakey type III thoraco-abdominal aneurysm is reported. The ischaemic liver resulting from prolonged aortic cross-clamping, extensive blood loss, citrated homologous blood replacement and low calcium levels is discussed. It is suggested that during aortic clamping the ischaemic liver cannot metabolise the excess citrate in homologous blood and recommend that homologous blood is avoided during this period--crystalloids and heparinised blood being used instead of citrated blood.