Laboratory and clinical effects of the infusion of ACD solution during plateletpheresis.

Transfusion of massive amounts of citrate anticoagulated blood during plateletpheresis with the intermittent flow centrifuge can produce symptoms and electrocardiographic changes suggestive of hypocalcemia. Following 15 procedures the ionized calcium decreased by an average of 32.4%, the average postpheresis serum citrate was 26.7 mg/dl and the QT interval was prolonged by 0.08 sec. Twelve plateletphereses performed with half-strength ACD solution caused an average decrease in ionized calcium of 16%, serum citrate levels of 12.5 mg/dl and QT prolongation of 0.04 sec. No donors experienced significant clinical symptoms with citrate infusion rates of less than 65 mg/kg/h. Solutions with citrate concentrations lower than ACD-A should be developed for use in plateletpheresis procedures involving citrate infusion rates greater than this.