title: New insights into the effect of rapid transfusion of fresh frozen plasma on ionized calcium.
abstract: OBJECTIVE
  1) To develop an in vitro system to simulate the kinetics of ionized calcium in mixed venous blood during rapid transfusion of fresh frozen plasma (FFP) and 2) to use the in vitro data to estimate the effect of the transfusion rate relative to cardiac output (CO) on ionized calcium.
  
  
  METHODS
  Experimental study.
  
  
  METHODS
  Research laboratory of an academic hospital.
  
  
  METHODS
  Citrated FFP was mixed with compatible heparinized whole blood at various volume ratios in vitro to simulate the mixed venous blood obtained at various flow ratios of FFP transfusion to the recipient's venous system in vivo. Ionized calcium was measured after each mixture.
  
  
  RESULTS
  Mixing FFP and whole blood at volume ratios of 0:100, 5:95, 10:90, and 15:85 yielded ionized calcium levels (mean ± SD, mmol/L) of 1.23, 0.81 ± 0.02, 0.54 ± 0.08, and 0.34 ± 0.02, respectively. The 50% reduction in ionized calcium occurred at a volume ratio of 7:93.
  
  
  CONCLUSIONS
  An instantaneous 50% reduction in ionized calcium occurs in vitro at a proportion equivalent to a transfusion rate of FFP representing 7% of CO.
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: Demet S
authors.initials: DS
authors.lastname: Sulemanji
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Bloom
authors.forename: Walter H
authors.initials: WH
authors.lastname: Dzik
authors.forename: Yandong
authors.initials: Y
authors.lastname: Jiang
mesh_terms: D001803:Blood Transfusion / Q000379:methods*; D002118:Calcium / Q000097:blood*; D006801:Humans; D008274:Magnesium / Q000097:blood; D010758:Phosphorus / Q000097:blood; D010949:Plasma; D012709:Serum Albumin / Q000378:metabolism; D013997:Time Factors
chemical_list: D012709:Serum Albumin; D010758:Phosphorus; D008274:Magnesium; D002118:Calcium