Hypocalcemia in trauma patients receiving massive transfusion.

Area of Science:

• Trauma Resuscitation
• Critical Care Medicine
• Biochemistry

Background:

• Massive transfusion protocols (MTP) are standard in trauma care.
• Citrate in transfused blood products can chelate calcium, leading to hypocalcemia.
• Hypocalcemia impairs coagulation and can worsen patient outcomes.

Purpose of the Study:

• To determine the incidence of hypocalcemia and severe hypocalcemia in trauma patients receiving MTP.
• To compare patient characteristics between severe and non-severe hypocalcemia groups.
• To evaluate calcium monitoring and replacement strategies.

Main Methods:

• Retrospective study of trauma patients (January 2009 - November 2013).
• Defined hypocalcemia as ionized calcium (iCa) < 1.12 mmol/L and severe hypocalcemia as iCa < 0.90 mmol/L.
• Analyzed demographics, laboratory values, blood product administration, and mortality.

Main Results:

• 97% of patients experienced hypocalcemia, and 71% had severe hypocalcemia.
• Severe hypocalcemia group had higher activated partial thromboplastin time, lactic acid, and mortality (49% vs. 24%).
• Patients with severe hypocalcemia received more blood products and calcium chloride, yet median iCa remained suboptimal.

Conclusions:

• Hypocalcemia is highly prevalent during MTP in trauma patients.
• Vigilant monitoring of ionized calcium is crucial.
• Effective management strategies for hypocalcemia during massive transfusion require further investigation.