Lee Grace, Arepally Gowthami M
Division of Hematology and Medical Oncology, Duke University Medical Center, Durham, North Carolina, USA.
J Clin Apher. 2012;27(3):117-25. doi: 10.1002/jca.21222. Epub 2012 Apr 24.
Anticoagulation is essential for maintaining the fluidity of extravascular blood on the apheresis circuit. Although both citrate and heparin are used as an anticoagulant during apheresis, citrate is preferred for the majority of exchange procedures because of its safety and effectiveness. Complications of citrate are primarily due to physiologic effects of hypocalcemia. Symptoms of hypocalcemia and other citrate-induced metabolic abnormalities affect neuromuscular and cardiac function and range in severity from mild dysesthesias (most common) to tetany, seizures, and cardiac arrhythmias. Oral or intravenous calcium supplementation is advised for decreased ionized calcium levels and/or symptomatic management of hypocalcemia. Heparin-based anticoagulation is limited to certain apheresis procedures (membrane-based plasma exchange, LDL apheresis, or photopheresis) or is used in combination with citrate to reduce citrate load. While effective, heparin anticoagulation is associated with an increased frequency of bleeding complications and heparin-induced thrombocytopenia. J. Clin. Apheresis 2012. © 2012 Wiley Periodicals, Inc.
抗凝对于维持单采回路中血管外血液的流动性至关重要。虽然在单采过程中枸橼酸盐和肝素都用作抗凝剂，但由于其安全性和有效性，枸橼酸盐在大多数置换程序中更受青睐。枸橼酸盐的并发症主要是由于低钙血症的生理效应。低钙血症的症状以及其他枸橼酸盐诱导的代谢异常会影响神经肌肉和心脏功能，严重程度从轻度感觉异常（最常见）到手足搐搦、癫痫发作和心律失常不等。对于离子钙水平降低和/或低钙血症的症状处理，建议口服或静脉补充钙剂。基于肝素的抗凝仅限于某些单采程序（膜式血浆置换、低密度脂蛋白单采或光化学单采），或者与枸橼酸盐联合使用以减少枸橼酸盐负荷。虽然肝素抗凝有效，但其与出血并发症和肝素诱导的血小板减少症的发生率增加有关。《临床单采杂志》2012年。©2012威利期刊公司。
