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Effects of liver function on ionized hypocalcaemia following rapid blood transfusion
1Department of Anaesthesia and Pain Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Insights
Rapid blood transfusions cause prolonged hypocalcaemia in liver disease patients. Impaired liver function exacerbates this condition, impacting cardiovascular health during liver transplantation.
Area of Science:
- Anesthesiology
- Hepatology
- Critical Care Medicine
Background:
- Massive transfusion-related hypocalcaemia poses significant cardiovascular risks.
- End-stage liver disease patients undergoing liver transplantation are particularly vulnerable.
Purpose of the Study:
- To compare the severity and duration of ionized hypocalcaemia between patients with normal and impaired liver function following rapid blood transfusion.
Main Methods:
- Patients were divided into three groups: liver transplant (LT), spinal surgery (SP), and saline control (SN).
- Ionized calcium levels were measured before and at multiple time points after transfusion with packed red blood cells (PRBCs) or saline.
Main Results:
- PRBC transfusion induced more severe hypocalcaemia than saline.
- Hypocalcaemia resolved faster in patients with normal liver function (group SP) compared to those with liver dysfunction (group LP).
- Persistent hypocalcaemia at 60 minutes correlated with vital signs and metabolic markers.
Conclusions:
- Rapid blood transfusion leads to more severe and prolonged ionized hypocalcaemia in patients with liver dysfunction.
- This highlights a critical concern for liver transplant recipients receiving massive transfusions.
Objective:
Hypocalcaemia detrimentally affects the cardiovascular system and massive transfusion-related hypocalcaemia is particularly severe in end-stage liver disease patients undergoing liver transplantation (LT). This study, therefore, compared the severity and duration of ionized hypocalcaemia between patients with normal and impaired liver function.
Methods:
Patients (n = 26 per group) were transfused at a rate of 10 ml/kg within 10 min with packed red blood cells (PRBCs) during LT (group LP) or spinal surgery (group SP), or were infused with 0.9% normal saline during spinal surgery (group SN). Serum levels of ionized calcium were assessed before (T(0)), just after (T(1)), and at 20 (T(2)) and 60 min (T(3)) after transfusion.
Results:
Transfusion with PRBCs caused more severe ionized hypocalcaemia than 0.9% normal saline at T(1). In contrast to the faster (20 min) normalization in group SP, ionized hypocalcaemia in group LP persisted at T(3). Serum ionized calcium levels at T(3) showed correlations with vital signs, blood glucose, serum potassium, base deficit and lactate.
Conclusion:
Rapid blood transfusion caused more severe and prolonged ionized hypo calcaemia in patients with liver dysfunction than in those with normal liver function.
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Ionic Bonds
When atoms gain or lose electrons to achieve a more stable electron configuration they form ions. Ionic bonds are electrostatic attractions between ions with opposite charges. Ionic compounds are rigid and brittle when solid and may dissociate into their constituent ions in water. Covalent compounds, by contrast, remain intact unless a chemical reaction breaks them.
Opposing Charges Hold Ions Together in Ionic Compounds
Ionic bonds are reversible electrostatic interactions between ions...

