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Laboratory and clinical effects of the infusion of ACD solution during plateletpheresis
Insights
Massive blood transfusions during plateletpheresis can cause hypocalcemia. Lower citrate concentrations are recommended for procedures exceeding 65 mg/kg/h to prevent donor symptoms and ECG changes.
Area of Science:
- Cardiovascular Physiology
- Hematology
- Biochemistry
Background:
- Plateletpheresis using intermittent flow centrifugation involves transfusing citrate-anticoagulated blood.
- Citrate infusion can lead to hypocalcemia, manifesting as symptoms and electrocardiographic changes.
Purpose of the Study:
- To investigate the impact of citrate anticoagulation during plateletpheresis on ionized calcium levels and electrocardiographic parameters in donors.
- To determine safe citrate infusion rates and explore alternative anticoagulant solutions.
Main Methods:
- Assessed changes in ionized calcium, serum citrate levels, and QT interval duration in donors undergoing plateletpheresis.
- Compared outcomes between standard citrate anticoagulation and half-strength ACD solution.
- Monitored for clinical symptoms related to citrate infusion.
Main Results:
- Standard citrate anticoagulation resulted in a 32.4% decrease in ionized calcium and 0.08 sec QT prolongation.
- Half-strength ACD solution led to a 16% decrease in ionized calcium and 0.04 sec QT prolongation.
- No significant symptoms occurred at citrate infusion rates below 65 mg/kg/h.
Conclusions:
- Citrate infusion during plateletpheresis can cause significant hypocalcemia and ECG changes.
- Lower citrate concentrations are advisable for procedures with infusion rates exceeding 65 mg/kg/h.
- Development of reduced citrate concentration solutions is warranted for plateletpheresis.
Abstract:
Transfusion of massive amounts of citrate anticoagulated blood during plateletpheresis with the intermittent flow centrifuge can produce symptoms and electrocardiographic changes suggestive of hypocalcemia. Following 15 procedures the ionized calcium decreased by an average of 32.4%, the average postpheresis serum citrate was 26.7 mg/dl and the QT interval was prolonged by 0.08 sec. Twelve plateletphereses performed with half-strength ACD solution caused an average decrease in ionized calcium of 16%, serum citrate levels of 12.5 mg/dl and QT prolongation of 0.04 sec. No donors experienced significant clinical symptoms with citrate infusion rates of less than 65 mg/kg/h. Solutions with citrate concentrations lower than ACD-A should be developed for use in plateletpheresis procedures involving citrate infusion rates greater than this.