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Changes in serum calcium fractions and citrate concentrations during massive blood transfusions and cardiopulmonary

T R Abbott

    British Journal of Anaesthesia
    |August 1, 1983
    PubMed

    Insights

    Massive blood transfusions in children undergoing scoliosis surgery did not alter serum ionized calcium levels. However, cardiopulmonary bypass significantly decreased ionized calcium due to high citrate concentrations.

    Area of Science:

    • Biochemistry
    • Pediatric Surgery
    • Anesthesiology

    Background:

    • Massive blood transfusions and cardiopulmonary bypass (CPB) can affect serum calcium levels.
    • Citrate in transfused blood products can chelate calcium, potentially leading to hypocalcemia.
    • Monitoring calcium and citrate is crucial in pediatric surgical patients undergoing major procedures.

    Purpose of the Study:

    • To investigate the impact of massive blood transfusion and CPB on serum calcium and citrate levels in pediatric surgical patients.
    • To determine the safety of massive blood transfusion in scoliosis surgery regarding calcium homeostasis.
    • To assess the changes in serum ionized calcium and citrate concentrations during and after CPB.

    Main Methods:

    • Serum total calcium, calcium fractions, and serum citrate concentrations were measured.
    • Patients undergoing scoliosis surgery with massive blood transfusion were studied.
    • Patients undergoing open-heart surgery with CPB were also studied.

    Main Results:

    • In scoliosis surgery, serum ionized calcium remained normal despite up to 100% blood volume replacement, provided infusion rates were below 30 ml kg-1 h-1.
    • During CPB, serum ionized calcium decreased significantly, correlating with high serum citrate concentrations.
    • Post-CPB, serum ionized calcium normalized, but serum citrate remained elevated fivefold for up to 5 hours.

    Conclusions:

    • Massive blood transfusion in scoliosis surgery appears safe for calcium homeostasis within specific infusion rate limits.
    • Citrate accumulation during CPB poses a significant risk for hypocalcemia, requiring careful monitoring.
    • Further research into managing citrate toxicity during CPB in pediatric patients is warranted.

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