Kishimoto Masahiro, Ohto Hitoshi, Shikama Yayoi, Kikuta Atsushi, Kimijima Izo, Takenoshita Seiichi
Department of Surgery II, Division of Blood Transfusion and Transplantation Immunology, School of Medicine, Fukushima Medical University, Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan.
Transfusion. 2002 Oct;42(10):1340-7. doi: 10.1046/j.1537-2995.2002.00205.x.
ACD-A solution containing sodium citrate and citric acid is used as an anticoagulant agent during peripheral blood progenitor cell (PBPC) harvesting, and in rare cases can cause fatal citrate intoxication. The aim of this study was to establish effective methods for stabilizing ionized calcium (ICa) levels during PBPC harvesting.
ICa was measured during 46 apheresis procedures conducted in 26 patients. Four patients in four procedures were infused with calcium gluconate solution before PBPC harvesting; three patients in six procedures were infused with calcium gluconate when symptoms of citrate intoxication appeared; and four patients in five procedures received a continuous infusion. Five patients in five procedures took an isotonic sports drink containing calcium when hypocalcemic symptoms appeared. The ICa level, blood pressure, and pulse rate were measured.
ICa declined rapidly from the preapheresis level of 1.081(+/-0.092) mM to 0.937(+/-0.081) mM (13.3%, p < 0.0001) 10 minutes after the start of apheresis and continued to decline until the completion of the procedure. When patients received a continuous infusion of calcium during apheresis, ICa was relatively stabilized. ICa significantly rose (6.1 +/- 3.6%, p < 0.02) within 2 to 5 minutes after oral intake of an isotonic sports drink containing calcium and was maintained within normal range for 31 to 55 minutes.
An isotonic sports drink containing calcium has a quick stabilizing and a longer maintenance effect on ICa. Thus, we recommend the intake of an isotonic sports drink containing calcium as the easiest and best method for preventing hypocalcemia during apheresis.
含柠檬酸钠和柠檬酸的ACD - A溶液在外周血祖细胞（PBPC）采集过程中用作抗凝剂，在罕见情况下可导致致命的柠檬酸盐中毒。本研究的目的是建立在外周血祖细胞采集过程中稳定离子钙（ICa）水平的有效方法。
在对26例患者进行的46次单采过程中测量ICa。4例患者在4次单采前输注葡萄糖酸钙溶液；3例患者在6次单采出现柠檬酸盐中毒症状时输注葡萄糖酸钙；4例患者在5次单采过程中接受持续输注。5例患者在5次单采出现低钙血症症状时饮用含钙等渗运动饮料。测量ICa水平、血压和脉搏率。
单采开始10分钟后，ICa从单采前的1.081（±0.092）mM迅速降至0.937（±0.081）mM（13.3%，p<0.0001），并在整个采集过程中持续下降。当患者在单采过程中接受钙持续输注时，ICa相对稳定。饮用含钙等渗运动饮料后2至5分钟内，ICa显著升高（6.1±3.6%，p<0.02），并在31至55分钟内维持在正常范围内。
含钙等渗运动饮料对ICa具有快速稳定和较长维持效果。因此，我们建议饮用含钙等渗运动饮料作为预防单采过程中低钙血症最简单且最佳的方法。
