Usefulness of Calcium Injection in Large-volume Leukapheresis / 대한수혈학회지

ABSTRACT

BACKGROUND: Hypocalcemia is the most common side effect in large-volume leukapheresis (LVL) for collection of peripheral blood stem cells (PBSCs). We evaluated the effect of intravenous calcium infusion on the hypocalcemic symptoms during LVL. METHODS: Seventy-six LVLs with hypocalcemic symptoms were participated in this study. LVLs were performed using Gambro Spectra (blood rate, 80 mL/min; whole blood to ACD-A with heparin, 241) until 20 L of blood was processed. Blood flow rate was slowed to 60-70% of initial in 35 LVLs (group A) and 20 mL of 3% CaCl2 was infused intravenously in 41 LVLs (group B). Serum levels of ionized calcium, total magnesium, and electrolytes were determined before and after each LVL and analyzed with students?-test. RESULTS: The observed hypocalcemic symptoms were perioral paresthesias (71%), digital numbness (17%), chest tightness (4%), chills (4%), headache (3%), and vomiting (1%). Serum ionized calcium decreased by 15.9% in group A (P<0.001) and increased by 1.3% in group B. Total magnesium in group A (11.4%, P=0.002) and potassium in both groups (9.5%, P<0.001 and 8.6%, P=0.02, respectively) were significantly reduced. In group A, hypocalcemic symptoms were not completely relieved but weakened in 63%, and blood flow rate had to be kept below 55 mL/min in 37%. In group B, the symptoms were relieved by 20 mL of 3% CaCl2 in 27% and by 40 mL in 73%. CONCLUSION: Reduction of blood flow for relief of hypocalcemia symptoms was only helpful in lightening the symptoms. Intravenous infusion of calcium was more effective and convenient to alleviate hypocalcemic symptoms and did not affect LVL procedures nor serum levels of ionized calcium.