Antonič Manja, Gubenšek Jakob, Buturović-Ponikvar Jadranka, Ponikvar Rafael
Clin Nephrol. 2017;88(13):53-56. doi: 10.5414/CNP88FX13.
To assess the possibility of using filtered plasma instead of postfilter ionized calcium (iCa) for the assessment of anticoagulation in plasma exchange (PE) with citrate anticoagulation.
140 PE treatments were performed using either 4% or 15% citrate at a comparable dose. Paired samples of postfilter blood and filtered plasma were taken for iCa measurements with a point-of-care analyzer. Anticoagulation was also assessed with a bedside clotting time and visual assessment of the circuit after procedures.
In 490 paired samples, mean postfilter iCa was 0.39 ± 0.14 mmol/L, and filtered plasma iCa was 0.33 ± 0.11 mmol/L. Mean bedside clotting time was 18 ± 7 minutes. Neither the postfilter (r = 0.03, p = 0.73) nor the filtered plasma iCa (r = 0.09, p = 0.25) correlated significantly with bedside clotting time. Bland-Altman analysis showed a modest agreement between filtered plasma and postfilter iCa values (mean difference -0.07 mmol/L, upper and lower 95% limits of agreement 0.10 and -0.23 mmol/L). Median visual assessment score was excellent at all three checkpoints.
CONCLUSIONS: A modest agreement between filtered plasma and postfilter iCa values could be acceptable if only a confirmation of anticoagulant effect is required. Measuring filtered plasma instead of postfilter iCa would reduce blood loss with sampling, which could be important in some settings. .
评估在枸橼酸盐抗凝的血浆置换（PE）中使用过滤后的血浆代替滤器后离子钙（iCa）来评估抗凝效果的可能性。
使用4%或15%的枸橼酸盐以相当的剂量进行了140次PE治疗。采集滤器后血液和过滤后血浆的配对样本，使用即时检验分析仪测量iCa。还通过床旁凝血时间和操作后对管路的视觉评估来评估抗凝效果。
在490对配对样本中，滤器后iCa的平均值为0.39±0.14 mmol/L，过滤后血浆iCa为0.33±0.11 mmol/L。床旁凝血时间的平均值为18±7分钟。滤器后iCa（r = 0.03，p = 0.73）和过滤后血浆iCa（r = 0.09，p = 0.25）与床旁凝血时间均无显著相关性。Bland-Altman分析显示过滤后血浆和滤器后iCa值之间存在适度的一致性（平均差异-0.07 mmol/L，一致性的95%上下限为0.10和-0.23 mmol/L）。在所有三个检查点，视觉评估分数的中位数均为优秀。
如果仅需要确认抗凝效果，过滤后血浆和滤器后iCa值之间适度的一致性是可以接受的。测量过滤后血浆而非滤器后iCa将减少采样时的失血量，这在某些情况下可能很重要。
