Department of Haematology, Umeå University Hospital, Umeå, Sweden.
Department of Clinical Microbiology, Division of Clinical Immunology, Umeå University, Umeå, Sweden.
Vox Sang. 2021 Sep;116(8):916-923. doi: 10.1111/vox.13075. Epub 2021 Jan 25.
Citrate-based anticoagulation reduces plasma potassium and free magnesium in patients undergoing peripheral stem cell collections. Whether the effects may be mitigated by pre-procedure oral electrolyte supplements has not been previously assessed.
Results from a historic cohort (2010-2013) guided a systematic prospective intervention in subjects deemed at risk for clinically meaningful hypokalaemia and hypomagnesaemia. From 2015 to 2019, 136 patients were enrolled in the study. Pre- and post-apheresis electrolyte levels were measured, and oral potassium and magnesium supplements were systematically administered based on the pre- electrolyte levels.
We saw a 37% absolute reduction in severe hypokalaemia and 39% absolute reduction in hypomagnesaemia in the prospective intervention cohort when compared to the historic cohort. Multivariate analyses indicated that part of the effect was due to the electrolyte intervention, while part of the effect likely stemmed from other procedure-related changes implemented during the study period.
Oral potassium and magnesium prophylaxis appear to reduce hypokalaemia and hypomagnesaemia following peripheral stem cell collection. Whether the effect size is sufficient to motivate the intervention warrants further investigation, preferably in a prospective randomized trial setting.
在外周血干细胞采集过程中，柠檬酸盐抗凝会降低患者血浆中的钾和游离镁。术前口服电解质补充剂是否可以减轻这些影响尚未得到评估。
一项历史队列研究（2010-2013 年）的结果为有发生临床显著低钾血症和低镁血症风险的患者提供了指导，我们对这些患者进行了系统的前瞻性干预。2015 年至 2019 年，共纳入了 136 名患者。在采集前后测量电解质水平，并根据电解质水平给予口服钾和镁补充剂。
与历史队列相比，前瞻性干预队列的严重低钾血症和低镁血症的绝对发生率分别降低了 37%和 39%。多变量分析表明，部分效果归因于电解质干预，而部分效果可能源于研究期间实施的其他与操作相关的改变。
口服钾和镁预防措施似乎可以减少外周血干细胞采集后的低钾血症和低镁血症。这种效果的大小是否足以促使进行干预还需要进一步研究，最好在前瞻性随机临床试验中进行。
