Comparison of different concentrations of calcium gluconate added in replacement fluid to maintain ionised calcium levels during therapeutic plasma exchange procedures

IF 1.4 4区医学 Q4 HEMATOLOGY Transfusion and Apheresis Science Pub Date : 2024-11-20 DOI:10.1016/j.transci.2024.104039

Nippun Prinja , Rekha Hans , Aarushi Sahni , Sangeeta Kumari , Preeti Paul , Divjot Singh Lamba , Aastha Takkar , Karthik Vinay Mahesh , Ratti Ram Sharma

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Abstract

Introduction

Therapeutic plasma exchange (TPE) is generally well tolerated but Anticoagulant Citrate Dextrose Solution A (ACD-A) can cause citrate mediated hypocalcaemia so, adding calcium gluconate to the replacement fluid is effective in preventing this complication. We aimed to compare the effect of different concentrations of 10 % calcium gluconate (9.3 mg of elemental calcium/100 ml Vs 18.6 mg of elemental calcium/100 ml) added to 5 % Human Serum Albumin (HSA) on intraprocedural and post procedural ionised calcium (iCa2+) levels in patients with neurological conditions undergoing TPE.

Material and methods

This study comprised of 100 TPE procedures divided into two groups of 50 each. In group 1, 5 ml of 10 % calcium gluconate was added in 500 ml of 5 % HSA (9.3 mg of elemental calcium/100 ml) and in group 2, 10 ml of 10 % calcium gluconate was added (18.6 mg of elemental calcium/100 ml) in 5 % of HSA. Ionised calcium was noted-pre, intra and post-procedure and compared within the groups along with other procedural parameters and adverse events if any.

Results

We observed that mean intraprocedural ionised calcium levels were comparable (p = 0.579) in both the groups, but post-procedural iCa2+ levels significantly decreased (p = 0.003) in group-1 as compared to group-2. Symptomatic hypocalcaemia was seen in 14 % of patients group 1 compared to 2 % in group-2. Vasovagal reactions were 8 % in group-1 % and 2 % in group-2.

Conclusion

Prophylactic addition of 18.6 mg of elemental calcium/100 ml of 5 % HSA is safe to maintain levels of iCa2+ throughout the procedure with lower chances of adverse events related to hypocalcaemia.

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在治疗性血浆置换过程中，比较置换液中添加不同浓度的葡萄糖酸钙以维持离子钙水平

导言治疗性血浆置换术（TPE）一般耐受性良好，但抗凝血剂枸橼酸葡萄糖溶液 A（ACD-A）可引起枸橼酸盐介导的低钙血症，因此在置换液中添加葡萄糖酸钙可有效预防这种并发症。我们的目的是比较在 5% 人血清白蛋白（HSA）中加入不同浓度的 10% 葡萄糖酸钙（9.3 毫克元素钙/100 毫升与 18.6 毫克元素钙/100 毫升）对接受 TPE 的神经系统疾病患者术中和术后离子化钙（iCa2+）水平的影响。第一组在 500 毫升 5% HSA 中加入 5 毫升 10% 葡萄糖酸钙（每 100 毫升含 9.3 毫克元素钙），第二组在 5% HSA 中加入 10 毫升 10% 葡萄糖酸钙（每 100 毫升含 18.6 毫克元素钙）。结果我们观察到，两组患者术中的平均离子钙水平相当（p = 0.579），但与第二组相比，第一组患者术后的 iCa2+ 水平明显下降（p = 0.003）。第一组有 14% 的患者出现症状性低钙血症，而第二组只有 2%。结论在整个手术过程中，预防性添加 18.6 毫克元素钙/100 毫升 5% HSA 是安全的，可维持 iCa2+ 水平，并降低与低钙血症相关的不良事件发生几率。

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来源期刊

Transfusion and Apheresis Science 医学-血液学

CiteScore

3.60

自引率

5.30%

发文量

181

审稿时长

42 days

期刊介绍： Transfusion and Apheresis Science brings comprehensive and up-to-date information to physicians and health care professionals involved in the rapidly changing fields of transfusion medicine, hemostasis and apheresis. The journal presents original articles relating to scientific and clinical studies in the areas of immunohematology, transfusion practice, bleeding and thrombotic disorders and both therapeutic and donor apheresis including hematopoietic stem cells. Topics covered include the collection and processing of blood, compatibility testing and guidelines for the use of blood products, as well as screening for and transmission of blood-borne diseases. All areas of apheresis - therapeutic and collection - are also addressed. We would like to specifically encourage allied health professionals in this area to submit manuscripts that relate to improved patient and donor care, technical aspects and educational issues. Transfusion and Apheresis Science features a "Theme" section which includes, in each issue, a group of papers designed to review a specific topic of current importance in transfusion and hemostasis for the discussion of topical issues specific to apheresis and focuses on the operators'' viewpoint. Another section is "What''s Happening" which provides informal reporting of activities in the field. In addition, brief case reports and Letters to the Editor, as well as reviews of meetings and events of general interest, and a listing of recent patents make the journal a complete source of information for practitioners of transfusion, hemostasis and apheresis science. Immediate dissemination of important information is ensured by the commitment of Transfusion and Apheresis Science to rapid publication of both symposia and submitted papers.