Uhl L, Maillet S, King S, Kruskall M S
Division of Laboratory and Transfusion Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Transfusion. 1997 Oct;37(10):1063-5. doi: 10.1046/j.1537-2995.1997.371098016446.x.
The citrate anticoagulant used during apheresis procedures is considered a safe medication because it is rapidly metabolized by the donor. However, acute, life-threatening hypocalcemia is possible if the infusion rate of citrate is increased.
A 54-year-old woman with metastatic breast cancer, but otherwise in good health, had just begun a fifth collection of hematopoietic peripheral blood progenitor cells by leukapheresis. The instrument's self-loading apheresis kit was primed uneventfully. Seven minutes into the procedure, the patient developed signs and symptoms suggesting severe hypocalcemia, including muscle spasms, chest pain, and hypotension. The citrate bag was discovered to have emptied, and a section of the anticoagulant tubing was protruding outside of the rotary pump. The patient's ionized calcium level was 0.64 mmol per L (normal range, 1.18-1.38 mmol/L). In subsequent experiments where the anticoagulant tubing was either improperly loaded at the outset or partially pulled out of the rotary pump, no instrument alarms sounded.
Citrate toxicity and life-threatening hypocalcemia can occur if the anticoagulant line of an apheresis instrument is not properly housed in its rotary pump or becomes disengaged during the procedure. Instrument manufacturers are encouraged to consider designs that allow the direct measurement of the volume of citrate delivered. In the interim, periodic visual and tactile confirmation of tubing placement during apheresis procedures is prudent.
单采程序中使用的枸橼酸盐抗凝剂被认为是一种安全的药物，因为它会被献血者迅速代谢。然而，如果枸橼酸盐的输注速率增加，可能会发生急性、危及生命的低钙血症。
一名54岁患有转移性乳腺癌但其他方面健康状况良好的女性刚刚开始通过白细胞单采术进行第五次造血外周血祖细胞采集。仪器的自动加载单采套件顺利灌注。手术进行7分钟后，患者出现了提示严重低钙血症的体征和症状，包括肌肉痉挛、胸痛和低血压。发现枸橼酸盐袋已排空，抗凝剂管路的一部分伸出了旋转泵外部。患者的离子钙水平为每升0.64毫摩尔（正常范围为1.18 - 1.38毫摩尔/升）。在随后的实验中，抗凝剂管路要么一开始就安装不当，要么部分从旋转泵中拔出，仪器均未发出警报。
如果单采仪器的抗凝剂管路在旋转泵中未妥善安置或在手术过程中脱离，可能会发生枸橼酸盐毒性和危及生命的低钙血症。鼓励仪器制造商考虑采用能够直接测量输注枸橼酸盐体积的设计。在此期间，在单采过程中定期通过视觉和触觉确认管路放置情况是谨慎的做法。
