Hegde Vikas, Setia Rasika, Soni Shivkumar, Handoo Anil, Sharma Sanjeev Kumar, Chaudhary Dharma, Kapoor Meenu
BLK Superspeciality Hospitals, Pusa Road, Rajendra Place, New Delhi 110006, India.
BLK Superspeciality Hospitals, Pusa Road, Rajendra Place, New Delhi 110006, India.
Transfus Apher Sci. 2016 Jun;54(3):373-6. doi: 10.1016/j.transci.2015.11.015. Epub 2016 Feb 15.
Citrate toxicity is one of the most frequent complications of apheresis procedures. It is caused by the infusion of the acid citrate dextrose (ACD), which chelates the calcium ions.
The aim of this study is to assess the effectiveness of prophylactic continuous infusion of calcium gluconate over intermittent bolus infusion to reduce citrate toxicity during large volume peripheral blood stem cell collection.
We retrospectively analysed the records of PBSC collection procedures performed from March 2010 to December 2013. Donors were selected as per the set guidelines. Machine used to perform the procedures was Cobe spectra. The study population was divided into 2 groups. One composed of intermittent intravenous bolus infusion at the onset of hypocalcaemic symptoms, the other composed of calcium gluconate administration as continuous infusion throughout the procedure.
The most common reported hypocalcaemic symptoms were mild perioral paresthesia followed by digital numbness. Of the 50 individuals who were injected with bolus calcium 40 (80%) individuals suffered from symptoms of hypocalcaemia, whereas 23 of 66 individuals (34.8%) suffered from hypocalcaemia in the continuous infusion group. This difference was significant (P < 0.001). Both groups were compared with respect to age, gender ratio, weight of the individuals, total blood volume processed, ACD used, calcium gluconate dose used, time taken for the procedure, the product volume. Significant difference was noticed only with respect to the product volume. This implies that the groups were comparable with respect to parameters such as age, gender ratio, weight of the individuals, total blood volume processed, ACD used, calcium gluconate dose used, and the time taken for the procedure. Also that significantly more products (244 v/s 204 ml) was collected in the continuous infusion group.
Our results show that prophylactic continuous IV administration of low dose calcium-gluconate throughout the PBSC harvesting procedure reduced the incidence as well as the severity of citrate related toxicity. This increases his/her tolerance to withstand longer durations of the procedure and collect more volume of the product, hence may reduce the number of sittings of the procedure.
枸橼酸盐毒性是血液分离术最常见的并发症之一。它是由输注酸性枸橼酸盐葡萄糖（ACD）引起的，ACD会螯合钙离子。
本研究的目的是评估预防性持续输注葡萄糖酸钙与间歇性推注输注相比，在大容量外周血干细胞采集过程中减少枸橼酸盐毒性的有效性。
我们回顾性分析了2010年3月至2013年12月进行的外周血干细胞采集程序记录。根据既定指南选择供体。用于执行程序的机器是Cobe spectra。研究人群分为2组。一组在出现低钙血症症状时进行间歇性静脉推注输注，另一组在整个程序中持续输注葡萄糖酸钙。
报告的最常见低钙血症症状是轻度口周感觉异常，其次是手指麻木。在接受推注钙的50名个体中，40名（80%）出现低钙血症症状，而在持续输注组的66名个体中，23名（34.8%）出现低钙血症。这种差异具有统计学意义（P < 0.001）。对两组在年龄、性别比例、个体体重、处理的总血量、使用的ACD、使用的葡萄糖酸钙剂量、程序所需时间、产品体积方面进行了比较。仅在产品体积方面发现了显著差异。这意味着两组在年龄、性别比例、个体体重、处理的总血量、使用的ACD、使用的葡萄糖酸钙剂量和程序所需时间等参数方面具有可比性。此外，持续输注组收集的产品明显更多（244对204 ml）。
我们的结果表明，在整个外周血干细胞采集过程中预防性持续静脉输注低剂量葡萄糖酸钙可降低枸橼酸盐相关毒性的发生率和严重程度。这提高了个体耐受更长程序时间并收集更多产品体积的能力，因此可能减少程序的次数。
