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The Play of Citrate Infusion with Calcium in Plateletpheresis Donors
Trupti Lokhande1, Sherin Thomas2, Guresh Kumar3
1Department of Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, 110 070 India.
Insights
Citrate infusion during platelet donation can cause hypocalcemia, with 10% of donors experiencing toxicity. Ionized calcium levels decrease during the procedure but typically recover afterward, with mild cases managed effectively.
Area of Science:
- Transfusion Medicine
- Hematology
Background:
- Citrate is a standard anticoagulant for plateletpheresis.
- Citrate toxicity, leading to hypocalcemia, is a known complication in platelet donors.
Purpose of the Study:
- To analyze the effects of routine citrate infusion on laboratory and clinical parameters during plateletpheresis.
- To compare citrate dosage between Haemonetics MCS+ and Trima Accel cell separators.
Main Methods:
- Study included 50 eligible plateletpheresis donors.
- Collected pre, mid, and post-procedure blood samples for analysis.
- Compared citrate dose and efficiency of two cell separators.
Main Results:
- Significant decrease in ionized calcium (iCa) during the procedure, with recovery post-donation.
- 10% incidence of citrate toxicity, characterized by non-recovery of iCa.
- Lower platelet counts required higher citrate doses.
- Trima Accel achieved target yield faster but used more citrate than Haemonetics MCS+.
Conclusions:
- Ionized calcium decreases during plateletpheresis but generally recovers.
- Mild citrate toxicity is manageable.
- Both cell separators efficiently collect platelets with minimal donor discomfort.
Abstract:
Citrate is the anticoagulant of choice for plateletpheresis. Citrate toxicity is common during plateletpheresis as citrate chelates calcium and causes hypocalcemia in donors. We have conducted this study to analyze the effects of routine citrate infusion during plateletpheresis on laboratory and clinical parameters. We also compared the dose of citrate delivered to donors during plateletpheresis using two different cell separators as Haemonetics MCS + and Trima Accel. The study was conducted on 50 plateletpheresis donors who were eligible for donation. Donor demographics and baseline parameters were recorded. Pre, mid and post-procedure blood samples were collected for hematological and biochemical analysis. We found a significant decrease in baseline iCa (1.23 ± 0.07 mmol/L) from start to mid-procedure (1.19 ± 0.006 mmol/L) which recovered at 30 min post procedure (1.2 ± 0.01 mmol/L). The incidence of citrate toxicity was 10%. In donors with citrate toxicity, the post-procedure recovery of iCa was not seen and there was a further decrease in iCa levels. We also found a significant fall in Hb and platelet count post plateletpheresis. We observed that lower PLT counts (< 200 × 103/µL) necessitated higher blood volume processing and therefore a higher anticoagulant (citrate) dose. The Trima Accel cell separator reached platelet target yield faster but with a higher citrate dose as compared to Hemonetics MCS + . Ionized calcium decreases significantly during plateletpheresis but recovers soon after the completion of the procedure. Serious adverse events were not observed during plateletpheresis. The mild citrate toxicity which occurred was easily managed by slowing the procedure and administering oral calcium to donors. Trima Accel and Hemonetics MCS + both collected platelets efficiently, with minimal donor discomfort.
