title: Prophylactic low dose continuous calcium infusion during peripheral blood stem cell (PBSC) collections to reduce citrate related toxicity.
abstract: BACKGROUND
  Citrate toxicity is one of the most frequent complications of apheresis procedures. It is caused by the infusion of the acid citrate dextrose (ACD), which chelates the calcium ions.
  
  
  OBJECTIVE
  The aim of this study is to assess the effectiveness of prophylactic continuous infusion of calcium gluconate over intermittent bolus infusion to reduce citrate toxicity during large volume peripheral blood stem cell collection.
  
  
  METHODS
  We retrospectively analysed the records of PBSC collection procedures performed from March 2010 to December 2013. Donors were selected as per the set guidelines. Machine used to perform the procedures was Cobe spectra. The study population was divided into 2 groups. One composed of intermittent intravenous bolus infusion at the onset of hypocalcaemic symptoms, the other composed of calcium gluconate administration as continuous infusion throughout the procedure.
  
  
  RESULTS
  The most common reported hypocalcaemic symptoms were mild perioral paresthesia followed by digital numbness. Of the 50 individuals who were injected with bolus calcium 40 (80%) individuals suffered from symptoms of hypocalcaemia, whereas 23 of 66 individuals (34.8%) suffered from hypocalcaemia in the continuous infusion group. This difference was significant (P < 0.001). Both groups were compared with respect to age, gender ratio, weight of the individuals, total blood volume processed, ACD used, calcium gluconate dose used, time taken for the procedure, the product volume. Significant difference was noticed only with respect to the product volume. This implies that the groups were comparable with respect to parameters such as age, gender ratio, weight of the individuals, total blood volume processed, ACD used, calcium gluconate dose used, and the time taken for the procedure. Also that significantly more products (244 v/s 204 ml) was collected in the continuous infusion group.
  
  
  CONCLUSIONS
  Our results show that prophylactic continuous IV administration of low dose calcium-gluconate throughout the PBSC harvesting procedure reduced the incidence as well as the severity of citrate related toxicity. This increases his/her tolerance to withstand longer durations of the procedure and collect more volume of the product, hence may reduce the number of sittings of the procedure.
authors.affiliation: BLK Superspeciality Hospitals, Pusa Road, Rajendra Place, New Delhi 110006, India. Electronic address: drvikashegde@gmail.com.
authors.forename: Vikas
authors.initials: V
authors.lastname: Hegde
authors.affiliation: BLK Superspeciality Hospitals, Pusa Road, Rajendra Place, New Delhi 110006, India.
authors.forename: Rasika
authors.initials: R
authors.lastname: Setia
authors.affiliation: BLK Superspeciality Hospitals, Pusa Road, Rajendra Place, New Delhi 110006, India.
authors.forename: Shivkumar
authors.initials: S
authors.lastname: Soni
authors.affiliation: BLK Superspeciality Hospitals, Pusa Road, Rajendra Place, New Delhi 110006, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Handoo
authors.affiliation: BLK Superspeciality Hospitals, Pusa Road, Rajendra Place, New Delhi 110006, India.
authors.forename: Sanjeev Kumar
authors.initials: SK
authors.lastname: Sharma
authors.affiliation: BLK Superspeciality Hospitals, Pusa Road, Rajendra Place, New Delhi 110006, India.
authors.forename: Dharma
authors.initials: D
authors.lastname: Chaudhary
authors.affiliation: BLK Superspeciality Hospitals, Pusa Road, Rajendra Place, New Delhi 110006, India.
authors.forename: Meenu
authors.initials: M
authors.lastname: Kapoor
mesh_terms: D000293:Adolescent; D000328:Adult; D002118:Calcium / Q000008:administration & dosage; D002125:Calcium Gluconate / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D019343:Citric Acid / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization; D006801:Humans; D006996:Hypocalcemia / Q000139:chemically induced / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D000072916:Peripheral Blood Stem Cells; D012189:Retrospective Studies
chemical_list: D019343:Citric Acid; D002125:Calcium Gluconate; D002118:Calcium
keywords: ACD; Apheresis; Bolus; Calcium; Continuous infusion