ACUTE CLINICAL HYPOCALCEMIC MYOCARDIAL DEPRESSION DURING RAPID BLOOD-TRANSFUSION AND POSTOPERATIVE HEMODIALYSIS - PREVENTABLE COMPLICATION

  • 1 January 1976
    • journal article
    • research article
    • Vol. 72  (4) , 503-511
Abstract
Despite experimental evidence that myocardial depression resulting from rapid transfusion of ACD [acid citrate dextrose] blood (citrate binds ionic Ca) is avoidable by simultaneous Ca administration, most hypovolemic patients receive Ca either after transfusion or not at all. Similar iatrogenic hypocalcemic myocardial depression occurs in normovolemic patients with known myocardial damage who are dialyzed for acute uremia when ACD blood prime is used at high initial flow rates (350 cm2/min) and when dialysis is performed against low Ca dialysate (2.5 meq/l or less). The following hypotheses were tested: rapid transfusion of as little as 1 unit of CPD [citrate phosphate dextrose] blood causes a significant reduction in ionized Ca; the depressive effect of CPD blood is significant and similar to that of ACD blood; rapid blood transfusion (ACD or CPD) is safe if Ca is given simultaneously; addition of Ca to the extracorporeal heparinized blood prime used in dialysis prevents initial depression and hemodynamic instability during dialysis is prevented when the dialysate is normocalcemic. Ionized Ca was reduced significantly by rapid transfusion of CPD blood. Acute myocardial depression noted with CPD blood was similar to that previously observed with ACD blood and was prevented during transfusion of either type of blood by simultaneous Ca administration. Hemodialysis in patients who have had cardiace surgery was safe if Ca was added to blood prime and dialysate was made normocalcemic.