Reduction of adverse citrate reactions during autologous large-volume PBPC apheresis by continuous infusion of calcium-gluconate.
BACKGROUND
Citrate-related side effects are common adverse reactions during PBPC apheresis. To reduce the incidence of citrate-related reactions, the effect of a continuous calcium-gluconate infusion on the appearance of hypocalcemic symptoms and on the subjective tolerance toward large-volume leukapheresis (LVL) was tested.


METHODS
A double-blinded, placebo-controlled trial was carried out in 50 patients undergoing standardized LVL at a median ACD-A ratio of 1.99 mg per kg and minute. Patients were randomly assigned to receive a continuous IV infusion of either saline or calcium-gluconate at a dose of 1.8 mmol calcium per hour. Subjective tolerance toward LVL was determined by standardized rating systems. Further, hormonal and electrolyte changes were monitored to assess the effect of continuous calcium infusion on calcium homeostasis.


RESULTS
Continuous IV administration of calcium-gluconate throughout LVL reduced the incidence of citrate-related effects by 65 percent. In patients who developed signs of hypocalcemia, the symptoms were weaker, and less medical intervention was needed to resolve clinical symptoms. The subjective tolerance toward LVL was superior in patients receiving calcium support compared to control patients. Continuous calcium infusion attenuated changes in serum phosphorus compared to patients receiving saline. No differences were observed in the variation of serum potassium and serum magnesium between the control group and the treatment group. The administration of calcium was not associated with technical problems related to the apheresis procedure, neither was any effect of calcium support on the total number of CD34+ cells collected observed.


CONCLUSIONS
These results indicate that continuous support of calcium-gluconate during LVL is an effective means of reducing the incidence of citrate-related symptoms and improving subjective tolerance toward LVL, without affecting the technical performance or the number of CD34+ cells collected.
Buchta
Christoph
C
Department of Blood Group Serology and Transfusion Medicine, AKH Wien, University Hospital of Vienna, Vienna, Austria.
Macher
Maria
M
Bieglmayer
Christian
C
Höcker
Paul
P
Dettke
Markus
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D001773:Blood Cells; D001781:Blood Component Removal / Q000009:adverse effects* / Q000592:standards; D002125:Calcium Gluconate / Q000008:administration & dosage / Q000627:therapeutic use*; D002951:Citrates / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*; D015994:Incidence; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D010919:Placebos; D012720:Severity of Illness Index; D013234:Stem Cells
D002951:Citrates; D010919:Placebos; D002125:Calcium Gluconate