长期多频次机采献血者体内钙磷代谢变化及口服葡萄糖酸钙改善柠檬酸盐抗凝剂不良反应的护理研究

目的：调查研究深圳市长期多频次机采献血者体内钙磷代谢变化及口服葡萄糖酸钙改善柠檬酸盐抗凝剂不良反应护理。方法采用随机数字表法将56例献血者按照含有口服葡萄糖酸钙的方式,分为采集前补钙组20例,采集中补钙组19例,未补钙组17例。结果跟踪观察三组献血者的血清钙水平、磷水平以及PTH水平,均出现不同变化。在采集后60 min中未补钙组中血清PTH为（160.23±29.76）pg／ml,采集中补钙组为（121.75±43.12）pg／ml,采集前补钙组为（104.75±20.99）pg／ml,三者相比差异有统计学意义（ P＜0.05）。结论献血者机采前10 min口服葡萄糖酸钙,是补充钙剂的最佳时机,有利于改善献血者低钙症状,提高机采过程中的舒适度,确保献血安全。     

碳酸钙口服片和碳酸钙咀嚼片对多次机采血小板男性献血者血清Ca2+和甲状旁腺激素水平的影响

目的 探讨碳酸钙口服片和咀嚼片对多次机采血小板男性献血者血清Ca2+和甲状旁腺激素(PTH)水平的影响.方法 采用简单随机抽样方法,选择2016年6月15日至7月15日,于深圳市血液中心捐献血小板的76例多次机采血小板男性献血者为研究对象.采用简单随机分组方法,将其分为3组:碳酸钙口服片组(n=27,机采前20 min口服碳酸钙D3片1片),碳酸钙咀嚼片组(n=25,机采前20 min口服碳酸钙D3咀嚼片1片)非未补钙组(n=24,机采前未服用任何补钙制剂).采用MCS+型血细胞分离机采集3组献血者血小板.并且分别于血小板机采前(机采前20 min),机采开始时,机采过程中(机采开始后约30 min),机采结束时,留取献血者静脉血5 mL.分别采用邻甲酚酞络合酮比色法和化学发光法,检测3组献血者的血清Ca2+和PTH水平.于血小板机采结束后,向碳酸钙口服片组和碳酸钙咀嚼片组献血者发放调查问卷,调查其对所服用碳酸钙制剂的满意度.采用统计学方法,比较3组献血者在血小板机采不同时间点的血清Ca2+和PTH水平,以及碳酸钙口服片组和碳酸钙咀嚼片组献血者对碳酸钙制剂的满意率.3组献血者一般资料比较,差异均无统计学意义(P＞0.05).结果 ①血小板机采前、机采开始时,3组献血者的血清Ca2+水平分别比较,差异均无统计学意义(P＞0.05).机采过程中,碳酸钙口服片组、碳酸钙咀嚼片组及未补钙组献血者的血清Ca2+水平分别为(2.26±0.06)mmol/L、(2.28±0.04) mmol/L和(2.24±0.06)mmol/L,3组比较,差异有统计学意义(F=3.47,P=0.04);碳酸钙口服片组与碳酸钙咀嚼片组,碳酸钙口服片组与未补钙组分别比较,差异均无统计学意义(P=0.08、0.36);碳酸钙咀嚼片组与未补钙组比较,差异有统计学意义(P=0.01).机采完成时,3组献血者的血清Ca2+水平分别为(2.25±0.06) mmol/L、(2.26±0.04) mmol/L和(2.17±0.05)mmol/L,3组比较,差异有统计学意义(F=21.29,P＜0.01);其中,碳酸钙口服片组和碳酸钙咀嚼片组比较,差异无统计学意义(P=0.56);但是均高于未补钙组,并且差异均有统计学意义(P＜0.01).②血小板机采前、机采开始时,3组献血者的血清PTH水平分别比较,差异均无统计学意义(P＞0.05).机采过程中,碳酸钙口服片组、碳酸钙咀嚼片组及未补钙组献血者的血清PTH水平分别为(110±21)pg/L、(102±26) pg/L和(161±40) pg/L;碳酸钙口服片组与碳酸钙咀嚼片组比较,差异无统计学意义(P=0.32);但是均低于未补钙组,并且差异均有统计学意义(P＜0.01).机采完成时,3组献血者血清PTH水平分别为(95±23)pg/L、(91±25)pg/L和(147±38)pg/L;碳酸钙口服片组与碳酸钙咀嚼片组比较,差异无统计学意义(P=0.09);但是均低于未补钙组,并且差异均有统计学意义(P＜0.01).③本研究共计发放调查问卷52份,均填写完整并收回.碳酸钙咀嚼片组献血者对碳酸钙制剂的满意率为92.0％(23/25),高于碳酸钙口服片组的59.3％(16/27),二者比较,差异有统计学意义(x2 =7.42,P＜0.01).结论 血小板机采前20 min口服碳酸钙咀嚼片,可使多次机采血小板男性献血者于机采过程中及机采结束后血清Ca2+和PTH水平保持稳定.碳酸钙咀嚼片口感良好,服用方便,可用于机采血小板献血者献血前使用.     

盐水负荷试验盐敏感者的大动脉弹性变化及其与C反应蛋白和单核细胞趋化蛋白1的相关性研究

目的 观察人群中盐敏感者的大动脉弹性变化及其与C反应蛋白、单核细胞趋化蛋白1的相关性。方法 选择原发性高血压患者64例以及正常对照组60例,通过口服盐水负荷试验及速尿缩容法将人群分别分为盐敏感者(SS)以及盐不敏感者(SR)。通过检测脉压指数、脉压、肱踝脉搏波传导速度(baPWV)作为大动脉弹性指标,使用ELISA法测定各组血清C反应蛋白(CRP)、单核细胞趋化蛋白-1(MCP-1),并观察其与大动脉弹性指标之间的相关性。结果 对照组中盐敏感者的脉压,baPWV明显高于盐不敏感者(61±18 vs 53±9 mmHg,t=7.71,P<0.05; 13.1±1.9 vs 11.9±2.8 m/s,t=3.65,P<0.05); 高血压组盐敏感者的脉压,baPWV亦高于盐不敏感者(71±15 vs 63±17 mmHg,t=13.86,P<0.05; 15.7±2.1 vs 14.3±1.8 m/s,t=4.04,P<0.05),差异均有统计学意义。对照组中盐敏感者的CRP,MCP-1水平高于盐不敏感者(6.89±2.75 vs 5.24±1.55 mg/L,t=22.02,P<0.05; 155.32±20.66 vs 100.11±10.75 pg/ml,t=75.97,P<0.05); 高血压组中盐敏感者的CRP,MCP-1水平亦高于盐不敏感者(8.28±3.61 vs 7.02±2.53 mg/L,t=21.86,P<0.05; 260.42±35.59 vs 200.18±45.17 pg/ml,t=63.72,P<0.05),差异均有统计学意义。CRP,MCP-1与脉压(r=0.451,0.374,P<0.05),baPWV(r=0.390,0.237,P<0.05)呈正相关性。结论 与盐不敏感者比较,盐敏感者的大动脉弹性降低,炎症反应可能参与了其大动脉弹性降低的过程。     

不同钙剂对男性多次双份机采献血者影响的研究

目的研究口服碳酸钙和葡萄糖酸钙对男性多次机采献血者双份机采中血清钙、磷和甲状旁腺素(PTH)的影响。方法随机抽取男性多次机采献血者77例,随机的分为3组:未补钙组,葡萄糖酸钙组(采前20 min口服葡萄糖酸钙4支,元素钙360 mg),碳酸钙组(采前20 min口服碳酸钙2片,元素钙1 200 mg),检测献血者机采前-20 min)、机采开始(0 min)、机采中(40 min)、后(80 min)血清钙、磷和PTH含量,观察献血者的柠檬酸盐抗凝剂相关反应。结果双份机采后,3个组的钙分别为(2.13±0.06),(2.23±0.07),(2.23±0.07)mmol/L;3个组双份机采后的PTH分别为(153±57),(121±35),(104±40)pg/L;机采中和机采后3组的钙、PTH比较,均为P0.01;采集后碳酸钙组与葡萄糖酸钙组比较,血清钙和PTH比较,葡萄糖酸钙、碳酸钙组与未补钙组比较,轻度抗凝剂反应的发生率均为P0.05。结论口服碳酸钙和葡萄糖酸钙能有效稳定机采中血清钙,PTH的波动,献机采前20 min口服碳酸钙是值得推荐的。     

血浆与红细胞不同输注比例对创伤性失血患者大量输血救治的影响

目的探讨大量输血时,输注不同比例的血浆和红细胞对创伤性失血患者救治的影响。方法回顾性分析本院2008年1月～2011年8月间,因创伤性失血需要输注悬浮红细胞10U以上的患者131例次。根据入院24h内输注血浆与悬浮红细胞(FP∶RBC)的比例,将患者分为高比例组(FP∶RBC≥1∶1,n=56)、中比例组(FP∶RBC=1∶2～1∶1,n=43)、低比例组(FP∶RBC≤1∶2,n=32)。采用单变量方差分析、配对t检验和Kaplan-Meier的统计方法,比较患者大量输血前后和3组之间凝血功能指标、在院期间红细胞输注总量、生存率的差异。结果与输血前相比,高比例组和中比例组患者输血后APTT、PT-INR均无明显变化,低比例组APTT、PT-INR均明显升高(P<0.01)。3组之间输血后的凝血功能指标、在院期间红细胞输注总量差异有统计学意义[输血后APTT,高vs中vs低:(37.3±12.4)vs(41.1±11.5)vs(49.9±14.0),P<0.05;输血后PT-INR,高vs中vs低:(1.11±0.19)vs(1.20±0.37)vs(1.66±0.62),P<0.05;在院期间红细胞输注总量,高vs中vs低:(19.8±6.3)vs(25.8±11.3)vs(26.6±8.0),P<0.01],但生存率差异无统计学意义。输血后高、中比例组凝血功能均显著优于低比例组(P<0.05),高比例组在院期间红细胞输注总量显著少于其他2组,低比例组与中比例组相比无差异。结论大量输血时,较高比例地输注血浆,有利于预防创伤性失血患者发生凝血功能障碍,降低患者住院期间红细胞输注总量,达到节约血液资源的目的。     

口服葡萄糖酸钙对单采血小板过程中献血者血清钙、镁和甲状旁腺素的影响

目的了解单采血小板过程中血清镁的变化情况和固定单采血小板献血者预防性口服补钙后其钙、镁和血清甲状旁腺素的变化情况。方法选择本中心固定单采血小板献血者49人,随机分为口服补钙组(n=20):采集血小板前口服葡萄糖酸钙20 m L(含钙共180 mg);未补钙组(n=29):采集血小板前未口服葡萄糖酸钙。采用全自动生化分析仪和化学发光免疫分析仪分别检测献血者在机采血小板0、30、60、90 min留取的血液标本中的血清钙、镁和甲状旁腺素含量,比较2组单采血小板献血者这3项指标的差异。结果机器采集血小板0、30、60、90 min时,补钙组和与未补钙组献血者的血清钙(mmol/L)分别为2.44±0.25 vs 2.39±0.21、2.31±0.18 vs 2.19±0.20、2.35±0.27 vs 2.25±0.22、2.33±0.27 vs 2.24±0.20;血清镁(mmol/L)分别为0.76±0.19 vs 0.74±0.19、0.72±0.16 vs 0.69±0.20、0.73±0.18 vs 0.71±0.19、0.73±0.16 vs 0.71±0.18;甲状旁腺素(pg/m L)分别为43.43±20.78 vs 48.16±42.31、166.26±88.77 vs 154.22±71.98、137.79±64.73 vs 138.77±62.99、104.09±76.16 vs 99.83±62.20。2组之间只有血清钙水平在30 min时补钙组明显高于未补钙组(P0.05)。结论单采血小板过程中存在血清镁的降低,预防性口服葡萄糖酸钙能缓解低钙血症,但对低镁血症影响有限。     

单采血小板前后献血者血清甲状旁腺素及电解质的变化

目的观察单采血小板前后献血者血清甲状旁腺素及电解质浓度的变化。方法选择单采血小板献血者45名,分为补钙组(n=11)和未补钙组(n=34),分别检测血小板采集前后血清甲状旁腺素(PTH)和钙、磷、钾、钠、镁离子浓度;献全血组(n=24)。结果单采后补钙组PTH浓度有统计学意义(t=2.472,P<0.05),未补钙组单采后磷浓度升高(t=3.191,P<0.05);单采血小板献血者采前血清磷、钙、钠的浓度低于对照组(t值分别为2.477,2.349和2.064,P<0.05),但仍在正常范围内。结论单采血小板会引起献血者血钙浓度短暂降低,但机体可自身迅速调节,不必常规补钙;单采血小板献血者采集前血清磷、钙、钠的浓度低于全血献血者。     

激活素A基因的过表达与大肠癌的侵袭转移

目的:探讨大肠癌组织中激活素A(activinA,ACTA)的表达,及其与大肠癌浸润、转移的关系。方法:应用RT-PCR和免疫组化法检测56例大肠癌组织及癌旁组织中ACTβA亚基mRNA和蛋白质的表达。结果:ACTβAmRNA在大肠癌组织中表达较癌旁组织高,差异有显著性[(0.643±0.361)vs(0.314±0.098),P<0.01]。ACTA蛋白在大肠癌组织中阳性表达率为44.6%,亦较癌旁组织的14.3%高,差异有显著性(P<0.01)。ACTβAmRNA的表达在大肠癌淋巴结转移组高于无转移组[(0.782±0.451)vs(0.484±0.373),P<0.01],Dukes’D期高于Dukes’A、B期,差异有显著性[分别为(0.813±0.441)vs(0.413±0.228),(0.813±0.441)vs(0.514±0.382),均P<0.01]。ACTA蛋白的表达在大肠癌淋巴结转移组高于无转移组(60.9%vs33.3%,P<0.01),Dukes’D期高于Dukes’A、B期,差异有显著性(分别61.5%vs30.0%,61.5%vs38.9%,均P<0.01)。结论:ACTA基因...     

太极拳锻炼结合补钙对绝经后女性骨密度的影响

目的：探讨太极拳锻炼结合口服钙对绝经后女性骨密度的影响。方法：绝经女性80例,随机分为4组, A组：太极拳锻炼加补充钙剂。B组：单独进行太极拳锻炼。C组：单纯进行补钙。D组：对照组,不进行任何干预。采用双能骨密度仪对受试者L2-4进行骨密度测定。各组间骨密度变化采用单因素方差分析,各组内干预前后、停止干预20周后的对比采用配对t检验。结果：A组骨密度增加明显,与D组比较具有显著性差异(P<0.05);停止干预20周后,C组明显降低(P<0.05)。组间综合疗效比较,A组优于B组(P<0.01),B组优于C组(P<0.001)。结论：太极拳锻炼和钙剂补充均能帮助绝经妇女防止骨量丢失,增加骨密度,太极拳锻炼加补钙的作用优于单纯太极拳锻炼,同时太极拳锻炼在停训后一段时间内有维持骨量的效应。     

糖皮质激素对老年哮喘患者骨代谢的影响及其治疗

目的研究糖皮质激素对老年哮喘患者骨代谢的影响及其治疗。方法观测54例口服、静脉点滴糖皮质激素的老年哮喘患者及健康查体的20例老年人右前臂远端骨密度(BMD)及血清骨钙素的变化。吸入布地奈德并口服钙尔奇D治疗干预。结果干预组的BMDzscore明显低于对照组(-0.46±0.14,0.15±0.06,P<0.001),血清骨钙素低于对照组(6.1±3.1)ng/ml,(10.1±3.9)ng/ml,P<0.001。治疗1年后,BMDzscore(-0.11±0.03)及血清骨钙素(10.1±3.9)ng/ml明显增加。结论全身应用糖皮质激素引起老年哮喘患者骨密度减低、骨钙素水平低下,改为吸入糖皮质激素、口服钙剂及维生素D能改善骨代谢。     

Importance of ionized magnesium measurement for monitoring of citrate- anticoagulated plateletpheresis

BACKGROUND: The infusion of citrate during apheresis may affect the levels of ionized magnesium in the blood. Hypomagnesemia and concomitant hypocalcemia could influence the parathormone response and could be responsible for some of the symptoms observed during apheresis. STUDY DESIGN AND METHODS: The study reports measurement of ionized magnesium by the new ion-selective electrode technique in response to citrate infusion in 15 donors undergoing continuous flow high-yield plateletpheresis. The monitoring included measurement of ionized calcium and parathormone every 30 minutes during the 120-minute apheresis (plus the next 30 minutes to assess recovery). RESULTS: Ionized magnesium fell by 30 +/− 4 percent (mean +/− SD, p<0.01), which contrasts with minor changes in total concentrations. Comparison of variations in the levels of ionized and total magnesium found major formation of complexes during citrate infusion. Ionized calcium fell by 15 +/− 3 percent (p<0.01), while parathormone peaked at 356 +/− 114 percent (p<0.01) of initial value after 30 minutes. Ionized cations and parathormone recovered by more than 50 percent within 30 minutes of the end of apheresis. CONCLUSION: An acute and steep drop in ionized magnesium occurs during citrate administration. The measurement of ionized magnesium should be included in future prospective studies of donor safety and parathormone regulation during apheresis.     

Randomized placebo-controlled study of oral calcium carbonate administration in plateletpheresis: I. Associations with donor symptoms

BACKGROUND: The effect of oral calcium (Ca) supplements in preventing citrate-induced symptoms during plateletpheresis was evaluated in a randomized, blinded, placebo-controlled trial. STUDY DESIGN AND METHODS: Twenty-three donors (12 men, 11 women) underwent four plateletpheresis procedures each, ingesting either 1 or 2 g of oral Ca carbonate or an equivalent placebo 30 minutes before donation. Ten of these subjects subsequently ingested 4 g of open-label Ca before a fifth procedure. All procedures were conducted at the same citrate infusion rate (1.5 mg/kg/min) for 90 minutes. RESULTS: Ingestion of 2 g of oral Ca resulted in a significant reduction in the severity of paresthesias and a significant, though modest, increase in serum ionized calcium (iCa), but no significant improvement in total symptom scores, compared to placebo. Minimal effects were seen with the 1-g dose. The two factors most highly correlated with development of severe symptoms were decreased levels of iCa and ionized magnesium (iMg) at 30 minutes into apheresis. Lower preapheresis serum albumin, creatinine, vitamin D, iMg, and total Mg concentrations were also significantly associated with symptoms. Women experienced more frequent and severe symptoms than men, however, gender was not associated with symptoms after adjustment for lower serum albumin, creatinine, and Mg levels. Ingestion of 4 g of Ca offered no improvement in symptoms or iCa levels compared with the 2-g dose. CONCLUSION: Prophylactic oral Ca was associated with modest improvements in citrate-induced symptoms and laboratory parameters. Baseline albumin and Mg levels were strongly predictive of the development of symptoms. In donors with a prior history of uncomfortable citrate-related effects, a 2-g oral Ca dose before apheresis is recommended.     

Effectiveness of supplemental oral calcium drink in preventing citrate-related adverse effects in peripheral blood progenitor cell collection

Peripheral blood progenitor cells (PBPCs) are a predominant graft source in allogeneic hematopoietic cell transplantation. Citrate-induced hypocalcemia remains the most frequent side effect of PBPC apheresis. Although the method for preventing severe adverse events is established, more efficient prophylaxis is required so that volunteer donors can donate PBPCs without pain and anxiety. We studied 80 healthy donors who underwent PBPC harvest between February 2014 and June 2020. Of these, 23 donors who underwent apheresis between February 2014 and December 2015 received only the standard prophylaxis of intravenous calcium gluconate. Oral calcium drinks were provided to 57 donors who underwent apheresis from January 2016 to June 2020 to supplement intravenous calcium gluconate prophylaxis. The ionized calcium (ICa) levels at multiple time intervals and the hypocalcemic symptoms were evaluated. Oral supplementation with a calcium drink maintained significantly higher ICa levels. Analysis using the inverse probability weighted regression adjustment method suggested that calcium drinks reduced the frequency of citrate-related reactions by 39.2 %. Administering a prophylactic oral calcium drink before apheresis with intravenous administration of calcium gluconate is promising to further reduce citrate-induced hypocalcemia in volunteer donors.     

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. STUDY DESIGN AND 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. CONCLUSION: 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.     

Placebo-controlled study of intravenous magnesium supplementation during large-volume leukapheresis in healthy allogeneic donors

BACKGROUND: Marked decreases in ionized magnesium (iMg) levels occur during large-volume leukapheresis (LVL); however, the effect of intravenous (IV) magnesium supplementation in this setting has not been carefully studied. STUDY DESIGN AND METHODS: Thirty healthy allogeneic peripheral blood progenitor cell donors receiving citrate anticoagulant with IV calcium prophylaxis were randomized to receive either IV magnesium (0.2 mg Mg per mL acid citrate dextrose-A) or placebo during LVL, with a double-blind design. RESULTS: Thirty subjects underwent 75 LVL pro- cedures, 37 with magnesium and 38 with placebo. Group characteristics were similar for sex, weight, citrate infusion rate (1.36 mg/kg/min vs. 1.37 mg/kg/min), and volume processed (16 L vs. 17 L). Serum iMg levels remained within the reference range with magnesium supplementation, but decreased 39+/-11 percent below baseline (p<10(-10)) after placebo, with greater decreases after consecutive procedures. Subjects receiving magnesium had more vigorous parathyroid hormone responses and higher glucose levels and also tended to have higher serum potassium and ionized calcium levels. Mild paresthesias, coldness, and nausea occurred in 28, 20, and 7 percent of donors, respectively, with no significant differences between groups. Severe symptoms (chest tightness) occurred in only one subject receiving placebo. CONCLUSION: IV magnesium supplementation exerts a significant impact on serum magnesium levels, but does not reduce the frequency or severity of the relatively mild citrate-related effects observed in LVL performed with continuous IV calcium prophylaxis.     

Treatment for the decline of ionized calcium levels during peripheral blood progenitor cell harvesting

BACKGROUND: ACD-A solution containing sodium citrate and citric acid is used as an anticoagulant agent during peripheral blood progenitor cell (PBPC) harvesting, and in rare cases can cause fatal citrate intoxication. The aim of this study was to establish effective methods for stabilizing ionized calcium (ICa) levels during PBPC harvesting. STUDY DESIGN AND METHODS: ICa was measured during 46 apheresis procedures conducted in 26 patients. Four patients in four procedures were infused with calcium gluconate solution before PBPC harvesting; three patients in six procedures were infused with calcium gluconate when symptoms of citrate intoxication appeared; and four patients in five procedures received a continuous infusion. Five patients in five procedures took an isotonic sports drink containing calcium when hypocalcemic symptoms appeared. The ICa level, blood pressure, and pulse rate were measured. RESULTS: ICa declined rapidly from the preapheresis level of 1.081(+/-0.092) mM to 0.937(+/-0.081) mM (13.3%, p < 0.0001) 10 minutes after the start of apheresis and continued to decline until the completion of the procedure. When patients received a continuous infusion of calcium during apheresis, ICa was relatively stabilized. ICa significantly rose (6.1 +/- 3.6%, p < 0.02) within 2 to 5 minutes after oral intake of an isotonic sports drink containing calcium and was maintained within normal range for 31 to 55 minutes. CONCLUSION: An isotonic sports drink containing calcium has a quick stabilizing and a longer maintenance effect on ICa. Thus, we recommend the intake of an isotonic sports drink containing calcium as the easiest and best method for preventing hypocalcemia during apheresis.     

Randomized placebo-controlled study of oral calcium carbonate supplementation in plateletpheresis: II. Metabolic effects

BACKGROUND: The metabolic effects of oral calcium (Ca) supplementation during plateletpheresis were evaluated in a randomized, placebo-controlled trial. STUDY DESIGN AND METHODS: Twenty-three donors underwent four plateletpheresis procedures each, receiving in random order, elemental Ca (Ca) 1 or 2 g orally, or a corresponding placebo, 30 minutes before donation. Ten of these donors underwent a fifth procedure using a 4-g Ca dose. All procedures were performed at a fixed citrate infusion rate of 1.5 mg per kg per minute. RESULTS: Oral Ca induced dose-sensitive changes in parathyroid hormone (iPTH), total (tCa), and ionized (iCa) calcium levels. Compared to placebo, the greatest improvement in tCa and iCa levels occurred after the 2-g Ca dose (tCa of 73, 89, and 25% above placebo levels at 60 min, using 1, 2, and 4 g of oral Ca, respectively). Twenty-four hours after apheresis, serum tCa and iCa levels were higher, and iPTH levels lower, in donors who received oral Ca rather than placebo. Marked increases in urinary Ca and magnesium (Mg) excretion occurred at the completion of apheresis, were unaffected by Ca dose, and returned to baseline within 24 hours. Plateletpheresis also induced significant changes in serum alkaline phosphatase, 1,25-dihydroxyvitamin D, and osteocalcin levels immediately and at 24 hours after apheresis. CONCLUSION: Plateletpheresis induces marked acute metabolic effects, with sustained changes evident up to 24 hours after the completion of apheresis. Oral Ca supplementation exerts a significant but clinically modest impact on selected laboratory variables associated with these effects. Further studies are indicated to examine the long-term impact of plateletpheresis, with or without Ca supplementation, on donor Ca balance and bone density.     

Therapeutic plasma exchange performed in tandem with hemodialysis without supplemental calcium in the apheresis circuit

Therapeutic plasma exchange (TPE) and hemopoietic progenitor cell (HPC) collection are apheresis procedures that can safely be performed in tandem with hemodialysis. Despite the return of citrate‐anticoagulated blood to the patient during HPC collection, it is not necessary to administer supplemental calcium during these procedures because the ionized calcium concentration is restored as the returning blood passes through the dialyzer. It is not known whether this applies to TPE, in which a mixture of blood and pharmaceutical albumin, an avid binder of plasma ionized calcium, is returned to the patient through the dialyzer. We report on three dialysis‐dependent patients who required TPE and underwent tandem treatments without supplemental calcium in the apheresis circuit. Overall, ionized calcium fell 4–12% (P = 0.0.024) and patients reported no symptoms of hypocalcemic toxicity. Tandem hemodialysis/TPE can be performed without supplemental calcium in the apheresis circuit. J. Clin. Apheresis 32:154–157, 2017. © 2016 Wiley Periodicals, Inc.     

柠檬酸盐抗凝剂对不同种族和性别人电解质代谢的影响

目的 探讨柠檬酸盐抗凝剂对不同性别和不同种族人电解质代谢的影响,为临床检测干预提供参考.方法 应用自身交叉、安慰剂对照研究模式,对22名年龄匹配的中国人(男女各11名)和10名白人男性志愿者以标准化的干预方案分别给予柠檬酸盐抗凝剂[1.5 mg/(kg·min)]和相同体积生理盐水(安慰剂)的输注(洗脱间隔期为2～3周);同时采集干预过程中的系列血样和尿样进行血、尿相关指标的检测.结果 22名中国男女试验对象间的基础清蛋白[男(43.05±1.81)g/L,女(42.26±2.67)g/L]和游离钙离子浓度[男(1.27±0.04)mmol/L,女(1.26±0.04)mmol/L]相近;柠檬酸盐的输入可导致中国女性较中国男性有更大的离子钙浓度降幅[女-28.68%(-20.00%～-35.2%),男-23.84%(-16.53%～-29.32%),t=3.19,P＜0.01],但其对血磷[男-18.81%(-3.16%～-25.09%),女-19.23%(-1.22%～-32.16%)]及清蛋白[男-0.32%(3.27%～-7.印%),女1.88%(6.03%～-9.31%)]的代谢影响性别间差异无统计学意义(t值分别为0.36,0.47,P均＞0.05);柠檬酸盐干预可同时导致中国人尿钙排泄增加[干预前0.34(0.09～0.87),干预后0.96(0.18～1.47),t=6.66,P＜0.01].与白人男性相比,中国男性具有较高的离子钙基础水平[中国男性(1.27±0.04)mmol/L,白人男性(1.22±0.02)mmol/L,t=3.7,P＜0.01]和较大幅度的清蛋白生理节律性波动[中国男性-11.72%(-5.70%～-14.21%),白人男性-1.74%(2.43%～-7.68%),t=7.43,P＜0.01].但两种族男性在柠檬酸盐致血离子钙[中国男性-23.84%(-16.53%～-29.32%),白人男性-21.95%(-18.31%～-30.92%)]、磷[中国男性-19.23%(4.65%～-32.16%),白人男性-12.68%(0.68%～-42.19%)]、清蛋白[中国男性-0.32%(1.05%～-7.60%),白人男性-1.39%(1.87%～-7.26%)]和尿钙排泄[中国男性237.70%(11.8%～935%),白人男性234.37%(5.45%～504.00%)]的代谢变化差异无统计学意义(t值分别为0.32、0.03、0.25和0.04,P均＞0.05).2种干预模式下试验对象的镁离子浓度均未见变化.结论 柠檬酸盐抗凝剂对机体镁、磷离子及清蛋白的代谢影响不存在着种族和性别间的差异.但其对钙离子代谢影响的性别差异性预示着在机采过程中女性比男性有更高的低钙血症副反应发生的可能.     

Clinical and clinicopathologic effects of plateletpheresis on healthy donor dogs

BACKGROUND: The safety and feasibility of plateletpheresis using a commercially available apheresis system (COBE Spectra, Gambro BCT) were evaluated in donor dogs, with characterization of its clinical and clinicopathologic effects. STUDY DESIGN AND METHODS: Fourteen adult dogs (18‐27.7 kg) underwent a plateletpheresis procedure. Complete blood counts were obtained at baseline, 2 hours after apheresis, and daily for 1 week. Blood was collected every 15 minutes for acid‐base and electrolyte analysis and measurement of serum citrate concentration. Dogs were monitored by continuous electrocardiogram and indirect blood pressure measurement. All dogs received prophylactic calcium (Ca) supplementation (10% Ca gluconate infusion at 15 mL/hr [139.5 mg Ca ion/hr]; the rate was increased based on serial measurement of ionized Ca [iCa] concentration). RESULTS: A high‐quality platelet concentrate (PC) was collected, with a mean total yield of 3.3 × 10¹¹ platelets (PLTs). The mean donor PLT count decreased from 356 × 10⁹ to 159 × 10⁹ per L after apheresis. The procedure was generally well tolerated, with no evidence of hypotension. Serum citrate concentration progressively increased, causing the ionized magnesium concentration to decrease by 45 percent and iCa to decrease to less than 1 mmol per L (mean baseline, 1.2 mmol/L) in 10 dogs, despite receiving 0.9 mg of Ca ion per mL acid‐citrate‐dextrose formula A. Lip licking was noted in 3 dogs, and generalized tremors and ventricular ectopy were noted in 1 dog. CONCLUSION: Canine plateletpheresis using the COBE Spectra is a feasible option for production of a PC. Hypocalcemia, however, is a potential serious adverse effect of plateletpheresis in dogs. Ca supplementation is recommended to limit clinical signs of hypocalcemia during the procedure.