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Cardiac failure associated with hypocalcemia

J K Denlinger, M L Nahrwold

    Anesthesia and Analgesia
    |January 1, 1976
    PubMed
    Summary
    This summary is machine-generated.

    Rapid blood transfusions can cause hypotension and cardiac issues due to low calcium levels. Slowing the transfusion rate reversed these effects, highlighting the importance of transfusion speed.

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    Area of Science:

    • Cardiovascular Physiology
    • Transfusion Medicine
    • Anesthesiology

    Background:

    • Pelvic exenteration and hemipelvectomy are extensive surgeries requiring significant blood replacement.
    • Citrated whole blood is commonly used in massive transfusion protocols.
    • Maintaining hemodynamic stability and electrolyte balance is critical during major surgery.

    Observation:

    • A patient receiving rapid transfusion of citrated whole blood developed acute hypotension and elevated central venous pressure.
    • Cardiac failure signs correlated with a sharp drop in serum ionized calcium (Ca++) concentration.
    • Slowing the transfusion rate led to the normalization of arterial blood pressure and increased serum Ca++.

    Findings:

    • Rapid citrated whole blood transfusion can induce hypocalcemia and cardiac dysfunction.

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  • Hypotension and elevated central venous pressure are associated with these transfusion-related complications.
  • Modulating transfusion rate can mitigate adverse cardiovascular events and correct hypocalcemia.

    • Implications:

    • Clinicians should monitor ionized calcium levels closely during rapid blood transfusions, especially with citrated products.
    • Adjusting transfusion rates may be a key strategy to prevent or manage transfusion-associated circulatory overload and hypocalcemia.
    • This case highlights the physiological impact of citrate metabolism and calcium binding during massive transfusion.