Controlled study of citrate effects and response to i.v. calcium administration during allogeneic peripheral blood progenitor cell donation.
BACKGROUND
Leukapheresis procedures are generally performed at citrate anticoagulation rates extrapolated from shorter plateletpheresis procedures. However, neither the metabolic effects nor the management of associated symptoms have been critically evaluated during leukapheresis in healthy donors.


METHODS
Symptom assessments (n = 315) and laboratory analyses (n = 49) were performed during 244 procedures performed with and 71 without prophylactic calcium (Ca) chloride or Ca gluconate given at a dose linked to the citrate infusion rate (1.0-2.2 mg/kg/min).


RESULTS
During leukapheresis of 12 to 25 L processed, ionized Ca and ionized magnesium (Mg) decreased as much as 35 and 56 percent, respectively, each exhibiting a tight negative correlation with marked increases in serum citrate levels. Significant increases in urinary Ca and Mg excretion accompanied the renal excretion of a large citrate load. Serum divalent cation levels remained depressed 24 hours after leukapheresis. Symptoms were more frequent in donors who were women, had low initial total Mg levels, and underwent procedures in which larger volumes were processed at higher citrate infusion rates. Ca infusions reduced clinically significant paresthesias by 96 percent and also attenuated decreases in serum potassium. Ca chloride maintained higher Ca levels than Ca gluconate.


CONCLUSIONS
Prophylactic Ca infusions safely attenuate the marked metabolic effects of citrate administration and promote faster, more comfortable, leukapheresis procedures.
Bolan
Charles D
CD
Department of Transfusion Medicine, Warren Grant Magnuson Clinical Center, Hematology Branch, National Heart, Lung and Blood Institute, NIH, Bethesda, MD 20892-1184, USA. cbolan@mail.cc.nih.gov
Cecco
Stacey A
SA
Wesley
Robert A
RA
Horne
McDonald
M
Yau
Yu Ying
YY
Remaley
Alan T
AT
Childs
Richard W
RW
Barrett
A John
AJ
Rehak
Nadja N
NN
Leitman
Susan F
SF
D002118:Calcium / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000652:urine; D002122:Calcium Chloride / Q000008:administration & dosage / Q000493:pharmacokinetics; D002125:Calcium Gluconate / Q000008:administration & dosage / Q000493:pharmacokinetics; D019343:Citric Acid / Q000097:blood / Q000493:pharmacokinetics* / Q000494:pharmacology; D005260:Female; D006412:Hematopoietic Stem Cells; D006801:Humans; D007262:Infusions, Intravenous; D007937:Leukapheresis / Q000379:methods*; D008274:Magnesium / Q000097:blood / Q000652:urine; D008297:Male; D010292:Paresthesia / Q000139:chemically induced / Q000209:etiology; D014184:Transplantation, Homologous
D019343:Citric Acid; D008274:Magnesium; D002122:Calcium Chloride; D002125:Calcium Gluconate; D002118:Calcium