巨噬细胞p38MAPK的激活与钙通道阻滞剂的关系

目的　探讨p38丝裂酶原活化蛋白激酶 (p38MAPK)在炎症反应细胞内的激活与细胞内第二信使—钙离子的关系。方法　分离大鼠腹腔巨噬细胞 (M) ,分为维拉帕米预处理组、SB2 0 35 80预处理组及对照组 ,再予内毒素 (LPS)刺激 ,观察细胞内磷酸化p38的变化及细胞上清液中肿瘤坏死因子 (TNF -α)含量的变化。结果　LPS处理后M中p38磷酸化水平较高 ,而SB2 0 35 80预处理组细胞内p38磷酸化水平明显低于对照组 (P <0 0 1) ,维拉帕米预处理组细胞内p38磷酸化水平与对照组相比无明显差异 (P >0 0 5 )。维拉帕米预处理组和SB2 0 35 80预处理组细胞上清液中TNF -α的含量均明显低于对照组。结论　钙通道阻滞剂维拉帕米可明显减少LPS刺激后MTNF -α的产生 (P <0 0 1) ;维拉帕米预处理组的M经LPS刺激后 ,磷酸化p38仍有较高水平的表达 ,提示细胞内钙离子并未参与p38的磷酸化过程。     

恒磁场对人脐静脉内皮细胞增殖的影响

目的　研究不同强度的恒磁场对人脐静脉内皮细胞增殖的影响。方法　体外培养的第 3代人脐静脉内皮细胞 ,分为对照组及不同剂量磁场组。各剂量磁场作用组的磁感应强度分别为 0 .0 5mT、0 .1mT、1mT、10mT、30mT、60mT和 10 0mT ,磁场作用时间均为 48h。用3H TdR法及MTT法测定细胞增殖。结果　 0 .0 5mT组细胞增殖显著高于对照组 (0 .2 92± 0 .0 10对 0 .2 2 0± 0 .0 0 8,P <0 .0 5 ) ;0 .1mT组细胞增殖与对照组相比无明显差异 (0 .2 31± 0 .0 0 9对 0 .2 2 0± 0 .0 0 8,P >0 .0 5 ) ;其余剂量组细胞增殖均显著低于对照组 (P <0 .0 5 )。结论　 0 .0 5mT的恒磁场可以促进人脐静脉内皮细胞的增殖     

蝙蝠葛苏林碱通过拮抗缓激肽诱导的胞内钙升高发挥神经保护作用

目的:研究蝙蝠葛苏林碱(DS)对缓激肽(BK)诱导神经细胞胞内钙升高的影响,并探讨其神经保护作用。方法:原代培养大鼠皮质神经元,应用BK(1μmol/L)诱导细胞内钙离子浓度升高;将细胞分为对照组,BK组,DS低、中、高剂量组;对照组不做任何处理,BK组给予1μmol/L的BK处理,DS低、中、高剂量组分别给予相应浓度(1×10~(-6)mol/L、1×10~(-5)mol/L、1×10~(-4)mol/L)的DS预孵育3 min,然后给予1μmol/L的BK处理。通过细胞内双波长荧光钙成像系统观察胞内游离钙离子的变化,采用MTT染色法检测神经元的损伤程度。结果:BK诱导可迅速升高原代培养大鼠皮质细胞内的钙离子水平。DS干预可部分逆转BK对胞内钙离子升高的影响(P0.05)。MTT结果显示,BK组神经元存活率明显低于对照组(P0.05);DS低、中、高剂量组的存活率均高于BK组(P0.05)。结论:DS可拮抗缓激肽诱导的细胞内钙升高,对胞内钙紊乱所致的神经细胞损伤具有一定保护作用。     

ELA对骨髓间充质干细胞氧化应激损伤的保护作用

目的:观察ELABELA(ELA)对过氧化氢(H_2O_2)诱导骨髓间充质干细胞(Mesenchymal stem cells,ELA(500 nM,1μM,5μM,10μM)组。利用H_2O_2诱导MSCs凋亡模型,即H_2O_2组细胞加入含400μM H_2O_2的无血清培养基,在37℃条件下培养6小时。MTS法检测细胞增殖及细胞活力,DCFH-DA荧光探针法检测细胞内活性氧(ROS)含量。结果:与Control组相比,H_2O_2组细胞的存活能力显著降低(P0.05),伴有细胞内活性氧水平明显升高(P0.05);与H_2O_2组相比,ELA组细胞的存活率显著增加(P0.05),且细胞内活性氧水平显著降低(P0.05),其中以5μMELA治疗对MSCs的保护作用最佳。结论:ELA能够减轻过H_2O_2诱导的MSCs氧化应激损伤,其中以5μM浓度ELA的保护效应以达到最佳。     

系统性红斑狼疮患者血清γ干扰素诱导的蛋白10表达水平与疾病活动的关系

目的　探讨血清γ干扰素诱导的蛋白 10 (IP 10 )水平 ,与红斑狼疮 (SLE)疾病活动的关系及其在SLE肾损伤中的可能作用。方法　收集了 112例SLE患者及 4 0名正常健康人和 30例类风湿性关节炎 (RA)患者血清。应用ELISA测定血清IP 10水平。结果　SLE活动组血清IP 10水平 (5 0 8 7± 2 5 2 4 ) μg/L较非活动组 (32 2 2± 95 9) μg/L和对照组 (12 4 9± 4 1 3) μg/L明显升高 (P<0 0 0 1)。活动性狼疮肾炎 (LN)组IP 10水平 (5 5 0 9± 2 0 6 1) μg/L与活动性无肾损伤组 (35 4 8±10 5 3) μg/L及对照组比较其差异均具有统计学意义 (P <0 0 0 1)。特别是Ⅲ型和Ⅳ型LN患者血清IP 10水平 (6 2 9 85± 16 4 ) μg/L升高最为显著 ,与Ⅱ型和Ⅴ型LN(30 2 9± 2 0 7 1) μg/L相比其差异具有统计学意义 (P <0 0 1)。另外 ,血清IP 10水平随着SLE疾病活动水平明显升高 ,与总的SLEDAI评分密切相关 (r=0 6 312 ,P <0 0 0 1) ,与SLEDAI肾评分亦密切相关 (r =0 6 880 ,P <0 0 0 1)。结论　以上结果表明IP 10可能在SLE肾损伤中起着十分重要的作用 ,血清IP 10水平与SLE疾病活动密切相关 ,可作为SLE疾病活动、尤其是监测狼疮肾损伤的重要指标。     

IL-13等因素对肾小球系膜细胞表达细胞周期调节负控蛋白p27的影响

目的 :探讨IL 13、ET 1、甲基强的松龙及肝素钠对肾小球系膜细胞表达细胞周期负控蛋白p2 7的变化。方法 :不同浓度IL 13 (10ng/mL、10 0ng/mL)、ET 1(10 7mol/L)、甲基强的松龙 0 5μg/mL、肝素钠 2 0 0mg/L和10 0 μg/L ,作用于培养的系膜细胞。流式细胞仪检测p2 7表达水平。结果 :IL 13 10ng/mL浓度组和 10 0ng/mL浓度组p2 7表达为 46 74± 3 2 5和 2 3 8± 2 56,与对照组比较差异有显著意义 (P <0 0 0 1,P <0 0 5) ,两不同浓度组之间差异有显著意义 (P <0 0 1)。ET 1刺激 14h和 18h后p2 7的表达分别为 14 76± 1 49和 12 18± 1 3 0 ,与对照组比较差异均有显著意义 (P <0 0 5,P <0 0 5)。甲基强的松龙 48h及 72h后p2 7表达为 9 9± 1 0 1和 9 12±0 93 ,与对照组比较明显降低 ,P <0 0 0 1。肝素钠 10 0mg/L浓度组和 2 0 0mg/L浓度组p2 7的表达分别为 2 6 94±1 2 3和 2 8 0 4± 0 99,较对照组明显升高 (P <0 0 5) ,不同浓度组间比较无明显差异。结论 :肾小球系膜细胞受不同因素作用后细胞周期调节负控蛋白p2 7表达水平不同。p2 7在调节系膜细胞增殖过程中起重要作用     

早期蛋白p52对人巨细胞病毒基因复制作用的实验研究

目的 :探讨HCMVDNA聚合酶辅助蛋白p5 2在病毒基因复制过程中的作用。方法 :采用体外实验方法建立HCMV感染细胞模型 ,在感染后不同时间段 ,FQ PCR法测定细胞内HCMVDNA拷贝数 ,免疫组化法检测病毒蛋白p5 2 ,计算机图像分析系统处理结果。同时光镜观察致细胞病变作用 ,电镜检查其超微结构的改变。结果 :感染后各组细胞内均能检测到HCMVDNA及p5 2表达 ,随感染时间延长 ,二者水平均升高 ,p5 2定位于感染细胞核内。与感染后 12h相比 ,此后各时段p5 2表达量均明显增高 (P <0 0 1) ;而至感染后 48h ,细胞内HCMVDNA量方明显高于感染后 12h(P <0 0 5 ) ,持续到感染晚期 ;同时细胞开始出现病变 ,并随感染时间延长、细胞内p5 2表达水平升高及HCMVDNA量增多而逐渐加重。结论 :早期蛋白p5 2在HCMVDNA复制过程中发挥重要作用 ,可有效促进病毒基因复制。     

在不同培养条件下微血管内皮细胞对骨髓造血干细胞增殖影响的比较

目的:探讨在体外不同培养条件下微血管内皮细胞(microvascular endothelial cells,MEC)对骨髓造血干细胞(hematopoietic stem cells,HSC)增殖的作用。方法:将来源于C57BL/6小鼠肺组织的MEC与来源于GFP小鼠骨髓的HSC用于非接触共培养、2 D接触共培养,并设置对照组HSC单独培养及MEC单独培养。采用细胞计数和CCK-8实验比较各组悬浮细胞在1、3、5和7 d的增殖情况。结果:MEC呈贴壁生长。HSC共培养组及单独培养组细胞在体外培养过程中悬浮细胞计数均有所增加; 2 D接触培养组与非接触共培养组中悬浮细胞比对照组中悬浮细胞更早进入对数生长期; 2 D接触培养组悬浮细胞增殖多于非接触共培养组及HSC单独培养组(P 0. 05);非接触共培养组悬浮细胞增殖多于HSC单独培养组(P 0. 05)。结论:体外培养HSC能使HSC增殖;M EC能促进HSC增殖; M EC还可以通过与HSC非接触共培养促进HSC增殖,这一效应与M EC分泌的细胞因子促HSC增殖作用有关; MEC与HSC直接接触培养对HSC的增殖作用比非接触共培养更强,这一效应与细胞-细胞接触对HSC增殖的调控有关。     

急性脑梗死患者血清T淋巴细胞亚群、白介素-6及肿瘤坏死因子-α的研究

目的 :探讨急性脑梗死患者血清T淋巴细胞亚群、白介素 6(IL 6)及肿瘤坏死因子 α(TNF α)的变化及其临床意义。方法 :测定 46例脑梗死患者急性期及 2周后血T淋巴细胞亚群、IL 6、TNF α水平并与 5 0例正常对照组比较。结果 :脑梗死组急性期CD3、CD4、CD4/CD8较正常对照组明显下降 (P <0 0 1) ,IL 6水平较正常对照组明显减低 (P <0 0 5 ) ,TNF α水平较正常对照组明显升高 (P <0 0 5 ) ;2周后 ,T淋巴细胞亚群水平与正常对照组比较差异无显著性 (P >0 0 5 ) ,IL 6水平较对照组升高 (P <0 0 5 ) ,TNF α仍较对照组升高 (P <0 0 5 )。结论 :脑梗死急性期患者存在显著的细胞免疫功能低下 ,IL 6对神经元损伤修复作用减弱 ,TNF α含量增高 ,促进了免疫功能改变及在脑梗死中的致病作用 ,提示改善人体免疫功能 ,阻断TNF α的表达 ,增强IL 6的抗损伤促修复作用 ,对预防和治疗脑梗死有重要的临床意义。     

帕米磷酸钠对大鼠成骨细胞增殖、分化的影响

目的观察二磷酸盐类药物帕米磷酸钠对体外培养大鼠成骨细胞增殖、分化的影响。方法取新生SD大鼠头盖骨分离成骨细胞体外培养 ;不同浓度帕米磷酸钠刺激后 ,四甲基偶氮唑盐 (MTT)法检测细胞增殖能力 ;取细胞上清液 ,碱性磷酸酶试剂盒检测细胞培养液中碱性磷酸酶活性。结果在 10 6M— 10 12 M时 ,帕米磷酸钠能促进大鼠成骨细胞增殖 (P <0 .0 5 ) ,10 4M则抑制细胞增殖 (P <0 .0 5 ) ;帕米磷酸钠抑制大鼠成骨细胞碱性磷酸酶活性。结论帕米磷酸钠能直接作用于大鼠成骨细胞 ,促进其增殖 ,但抑制分化     

Sickle cell anemia. Pathophysiological role of increased intracorpuscular calcium and changes during treatment with pentoxifylline

Summary In a group of 20 homozygous (SS) sickle cell patients (age range 8·28 years) determinations of red blood cell and platelet calcium as well as platelet aggregation and platelet malondialdehyde formation were performed before and after oral treatment with 28.4 mg/kg daily pentoxifylline (Trental?) for 30 days. After a previous observation period, drug treatment was started at the onset of painful exacerbation, which thereby subsided within 26.4±9.6h; no further pain symptoms were observed during the treatment. All the above mentioned parameters were found to be increased before treatment when compared to normal subjects and they fell progressively during treatment: red blood cell calcium 86.0±17.9 μmol/l (before), 45.0±8.2 μmol/1 (after); intraplatelet calcium 31.6±10.5 μmol/10⁹ platelets (before), 18.0±5.2 μmol/10⁹ platelets (after); malondialdehyde 18.6±8.9 μmol/10⁹ platelets (before), 9.3±3.9 μmol/10⁹ platelets (after). Also platelet aggregation index was significantly reduced. It is concluded that clinical improvement of patients was attributable to the effects of pentoxifylline on both red blood cells and platelets.     

苦参碱触发的K562细胞胞内钙信号的动态变化

目的 研究苦参碱诱导K562细胞分化的信号转导机制。方法 以Fura 2-AM为荧光探针,定量分析苦参碱作用后K562细胞内钙离子浓度的动态变化。结果 经苦参碱处理后,在胞外有钙的情况下,K562细胞内钙离子浓度由129．02nmol／L升至207．50nmol／L,并维持较长时间;在无胞外钙的情况下,胞内钙离子浓度由129．02nmol／L迅速升至164．22nmol／L,并迅速恢复。两者的增高幅度均与苦参碱浓度呈正相关。结论 在苦参碱诱导K562细胞分化过程中,钙离子浓度的变化是一重要的与细胞的增殖抑制和分化相关的早期信号。     

Triggering of suicidal erythrocyte death by radiocontrast agents

Background According to in vitro observations, gadolinium‐containing magnetic resonance (MRT) contrast agents stimulate suicidal cell death or apoptosis. Similar to nucleated cells, erythrocytes may undergo suicidal death or eryptosis, characterized by cell shrinkage and cell membrane scrambling with phosphatidylserine (PS) exposure at the erythrocyte surface. Eryptosis is triggered by increased cytosolic Ca²⁺‐activity. This study explored whether gadolinium‐containing MRT contrast agents stimulate eryptosis. Materials and methods Annexin V‐binding reflecting PS exposure and forward scatter reflecting cell volume were determined in erythrocytes within freshly drawn blood from patients (8♀, 3♂, 29–72 years) prior to and 10 min after administration of gadoterate meglumine (0·1 mmol kg^?1 b.w. Dotarem^®; six patients) or gadobenate dimeglumine (0·05 mmol kg^?1 bw Multi Hance^®; five patients). In a separate series, eryptosis was determined prior to and following in vitro incubation of erythrocytes from 16 blood donors for 4 h with gadoterate meglumine (5 mM Dotarem^®) or gadobenate dimeglumine (5 mM Multi Hance^®). Finally, eryptosis and Fluo3 fluorescence reflecting cytosolic Ca²⁺ were determined in vitro following exposure to Gd³⁺. Data were analysed using paired t‐test or anova with Tukey’s test as post‐test. Results The MRT contrast agents such as gadoterate meglumine (Dotarem^®) and gadobenate dimeglumine (Multi Hance^®) significantly increased the percentage of eryptotic cells. Moreover, in vitro exposure to gadoterate meglumine (5 mM), gadobenate dimeglumine (5 mM) or Gd³⁺ (1·9 μM) stimulated eryptosis in vitro. The effect of Gd³⁺ was paralleled by increase in cytosolic Ca²⁺‐activity. Conclusions MRT contrast agents may stimulate suicidal erythrocyte death or eryptosis in vitro and in vivo.     

钙离子载体诱导慢性髓系白血病细胞分化为树突状细胞的实验研究

本研究旨在探索钙载体（calcium ionophore,CI）诱导慢性髓性白血病（CML）细胞分化成树突状细胞（DC）的作用,了解诱导产生P210蛋白的情况和刺激自身T细胞产生针对CML细胞的细胞毒作用。用CI和粒－单集落刺激因子（GM—CSF）联合诱导CML病人骨髓来源的单个核细胞,通过倒置显微镜和电子显微镜观察细胞的形态变化和超微结构,用流式细胞仪检测细胞表面分化抗原的变化和变化过程;用Western blot检测CML特异的肿瘤标志物P210蛋白在DC中的表达;通过乳酸脱氢酶（LDH）实验评估CI诱导的CML—DC刺激自身T细胞产生抗CML细胞的细胞毒作用。结果表明：CML细胞经CI和GM—CSF联合诱导96小时后在倒置显微镜和电子显微镜下观察到DC典型的形态结构;流式细胞仪检测显示CD83、CD86、CD80、HLA—DR、CD40等细胞表面分化抗原的表达显著提高;Western blot实验表明,生成的CML—DC有P210蛋白的表达,与未经诱导的CML单个核细胞比较,用CI和GM—CSF联合诱导生成的CML－DC的P210蛋白表达水平降低;LDH实验表明,这些CML—DC刺激的自身T细胞对CML细胞的杀伤率显著高于用CML细胞刺激的自身T细胞。结论：CI和GM—CSF联合能快速诱导CML细胞分化成DC,这些CML—DC表达CML细胞特异的肿瘤标志物P210蛋白,但其表达水平较未经诱导的CML单个核细胞低;CML细胞经诱导生成的CML—DC能够刺激自身T细胞产生抗白血病细胞毒性。     

Assessment of corrected QT interval in sickle-cell disease patients who undergo erythroapheresis

Extension of the QT interval is characterized by syncope and cardiac arrest and often occurs in association with medical therapies and procedures. Whether erythroapheresis (EPH) could influence the QT interval duration in patients with sickle cell disease (SCD) is not known. We aimed to investigate the effects of EPH on the heart rate-corrected QT (QTc) interval. The study included 25 patients with SCD who underwent 34 EPH procedures. Two independent observers measured QTc interval duration from electrocardiograms performed continuously for 3 min at three different points during the EPH procedures (prior to EPH, after completion of 50% EPH and 15 min after EPH). Multiple regression analysis was used to determine if the ionized plasma calcium, the level of plasma magnesium, citrate infusion rate and painful crisis significantly contributed to the QTc interval. There was a non-significant trend (P = 0.184) towards increased QTc in sickle cell patients during EPH compared with pre-EPH values. QTc prolongation (>440 ms) occurred in 72% of the procedures. Fifty percent QTc values returned to baseline after the procedure. The independent variables were not significantly associated with QTc interval. Exchange procedures can induce QTc prolongation in patients with SCD.     

SENSITIVITY OF PANCREATIC BETA CELL TO CALCIUM CHANNEL BLOCKERS. AN ELECTROPHYSIOLOGIC STUDY OF VERAPAMIL AND NIFEDIPINE

Microelectrodes were used to study the comparative effects of 2 calcium channel blockers on glucose-induced electrical activity in mouse beta cells. In 2.8 mM glucose, verapamil (10(-5) M), but not nifedipine (10(-7) M), induces a silent depolarization. In 11.1 mM glucose, verapamil (10(-7) to 5.10(-5) M) induces continuous spike activity by a decrease in the maximum repolarization potential. Nifedipine (10(-10) to 10(-6) M) induces the same activity, but subsequent to a hyperpolarization of the cell at the maximal repolarization potential followed by a silent phase to the plateau potential. The 2 drugs induce a dose-dependent decrease in spike frequency without any change in spike amplitude. In 22 mM glucose exposure to nifedipine, but not to verapamil, induces a transient period of slow-wave activity. The 2 drugs induce a dose-dependent decrease in spike frequency. At higher concentrations (nifedipine greater than 10(-7) M; verapamil greater than 10(-6) M) they induce the disappearance of spikes through a decrease in amplitude. These results show that the beta cell is more sensitive to nifedipine (ED50 = 3 X 10(-8) M) than to verapamil, and that glucose stimulation increases the cell's sensitivity to verapamil (11.1 mM glucose: ED50 = 10(-5) M versus 5 X 10(-7) M in 22 mM glucose) but not to nifedipine.     

草酸钙晶体对大鼠肾小管上皮细胞骨桥蛋白表达的影响

目的探讨一水草酸钙(calcium oxalate monohydrate,COM)晶体对大鼠肾小管上皮细胞中骨桥蛋白(osteopontin,OPN)表达的影响。方法选用SD大鼠的肾皮质原代培养出肾小管上皮细胞并制成爬片,将爬片的肾小管上皮细胞随机分为A、B、C、D、E5组。A组不加COM(11例);B组1 mmol/L浓度COM(17例);C组3 mmol/L浓度COM(18例);D组5 mmol/L浓度COM(18例);E组10 mmol/L浓度COM(17例)。采用免疫组织化学法(SABC)检测各组肾小管上皮细胞中OPN的表达,并进行阳性细胞计数和各组间比较。结果 OPN的表达主要定位于细胞质,呈棕褐色。各组OPN阳性表达率:A组54.5%;B组64.7%;C组77.8%;D组88.9%;E组76.5%。随着COM浓度增加,OPN表达逐渐增强,到5 mmol/L浓度COM时OPN表达最强(P0.01),而10 mmol/L浓度COM时OPN表达反而下降,接近3 mmol/L浓度COM水平(P0.05)。结论大鼠肾小管上皮细胞受COM刺激后OPN表达增强,但高浓度COM使OPN表达减弱,提示高浓度COM通过损伤肾小管上皮细胞使OPN表达下降,进而形成结石。     

无血清体外培养树突状细胞的研究

本研究的目的是建立对外周血来源的树突状细胞（dendritic cell，DC）的无血清培养方案。以含胎牛血清（FCS）、人AB血清的培养液作为对照。分离健康志愿者外周血单个核细胞（PBMNC），在不同培养液中分别加入GM—CSF（100ng／ml）、IL-4（500U／ml）培养6天，再分别加入钙离子载体A23187（100ng／ml）继续培养24小时，于倒置显微镜下观察细胞形态，流式细胞术分析细胞表型，MTT比色法检测各组DC刺激同种异体外周血T细胞增殖的能力和DC刺激的T细胞对K562细胞的杀伤作用。结果表明：无血清培养组培养出典型形态的DC，其表面CD14分子的表达明显减少，CD83、HLA—DR、CDw123分子的表达明显增高，具有明显的刺激同种异体T细胞增殖的能力和DC刺激的T细胞对K562细胞的杀伤作用。无血清组与两个含血清的对照组比较，组间无显著性差异（P〉0．05）。结论：无血清培养液培养的DC与含血清的培养液培养的DC相比，无显著性差异。DC无血清培养具有临床应用前景。     

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.     

Increased risk of citrate reactions in patients with multiple myeloma during peripheral blood stem cell leukapheresis

The citrate based anticoagulant ACD is commonly used in apheresis procedures. Due to its ability to decrease ionized calcium, citrate may cause unpleasant symptoms, such as paresthesias and muscle cramps, in patients undergoing therapeutic and donor apheresis. We noticed that patients with multiple myeloma (MM) undergoing autologous stem cell leukapheresis appeared to have more citrate reactions when compared to other patients undergoing the same procedure. A retrospective chart review was performed to evaluate 139 (of 151) consecutive patients with MM, amyloidosis, hematological and solid malignancies who had autologous peripheral blood stem cell collection between January 2007 and February 2008. Citrate reactions, ranging from mild (e.g., perioral tingling and parasthesias) to severe (e.g., nausea/vomiting and muscle cramps) were noted for 35 patients. Twenty‐three of 63 patients with MM had documented citrate reactions, which was significantly higher than those with other hematological and solid malignancies (37% vs. 20%; P < 0.05, Relative Risk (RR) = 1.9). The severities of citrate reactions were the same in both groups; approximately 50% of patients in each group received i.v. calcium gluconate for treatment of hypocalcemia. No correlation between bisphosphonate therapy and citrate reactions were noted in our study group. Examination of available laboratory values related to calcium homeostasis, liver, and renal function failed to reveal a mechanism for the increase in citrate reactions observed. In summary, this single institution retrospective study indicates that patients with MM are more sensitive to citrate‐induced hypocalcemia during leukapheresis when compared to patients with other hematological and solid malignancies. Strategies for decreasing citrate reactions (e.g., supplemental calcium and slowing return rates) should be considered for patient safety and comfort, especially in the MM population, on a prophylactic rather than reactive basis. J. Clin. Apheresis 25:188–194, 2010. © 2010 Wiley‐Liss, Inc.