Weinstein Robert, Haynes Stefanie, Zhao Yong, Hickson Elda, Linden Jeanne, St Pierre Patricia, Ducharme Paula, Sulmasy Paula, Graves Molly, Bailey Jeffrey A, Welch Linda, Simard Amie, Vauthrin Michelle, Greene Mindy
Transfusion Medicine and Apheresis Service, UMass Memorial Medical Center, Worcester, Massachusetts.
Division of Transfusion Medicine, UMass Memorial Medical Center, Worcester, Massachusetts.
J Clin Apher. 2018 Feb;33(1):60-64. doi: 10.1002/jca.21565. Epub 2017 Jun 27.
Hypocalcemic toxicity, because of return of citrate anion to the donor, is the major toxicity of apheresis platelet donation. Oral calcium carbonate, given prophylactically at the start of donation, has shown limited ability to alleviate this toxicity. We examined whether repeated prophylactic doses of calcium carbonate, or of a liquid preparation containing calcium citrate, calcium phosphate, and vitamin D , would be more effective at preventing symptoms of hypocalcemic toxicity. Symptoms were reported by 48% of donors who received no prophylaxis and 60% of donors who received 1000 mg of oral calcium carbonate at the start of, and every 20 minutes during, donation (P = 0.711). Only 19.2% of donors who received the liquid preparation (1000 mg calcium, 1000 IU vitamin D ) reported symptoms (P = 0.040 versus no prophylaxis, P = 0.039 versus calcium carbonate). This difference was not because of gender, weight, age, or blood volume of the donor. Neither calcium preparation prevented a measurable fall in plasma ionized calcium during donation. We conclude that liquid calcium citrate/calcium phosphate/vitamin D provides effective prophylaxis against hypocalcemic toxicity during platelet donation, however it does not prevent a fall in plasma ionized calcium.
由于枸橼酸阴离子返回供体导致的低钙血症毒性是单采血小板捐献的主要毒性。在捐献开始时预防性给予口服碳酸钙，已显示出缓解这种毒性的能力有限。我们研究了重复预防性给予碳酸钙或含有柠檬酸钙、磷酸钙和维生素D的液体制剂，在预防低钙血症毒性症状方面是否更有效。未接受预防措施的捐献者中有48%报告出现症状，在捐献开始时及捐献期间每20分钟接受1000毫克口服碳酸钙的捐献者中有60%报告出现症状（P = 0.711）。接受液体制剂（1000毫克钙，1000国际单位维生素D）的捐献者中只有19.2%报告出现症状（与未预防相比，P = 0.040；与碳酸钙相比，P = 0.039）。这种差异不是由于捐献者的性别、体重、年龄或血容量。两种钙制剂均未防止捐献期间血浆离子钙出现可测量的下降。我们得出结论，柠檬酸钙/磷酸钙/维生素D液体制剂可有效预防血小板捐献期间的低钙血症毒性，然而它并不能防止血浆离子钙下降。
