Abstract
The effect of exchange transfusion (ET) on plasma ionized calcium (Ca++) was studied in 27 exchange transfusions on 19 infants using CPD blood. The addition of 0.1 g Ca gluconate per 100 ml exchanged did not prevent a fall in Ca++ in term or preterm infants (Group I). ET was then performed with 0.5 g CaCl2 (Group II) or 0.1 g CaCl2 (Group III) added to 450 ml heparinized CFD blood. In Group iI Ca++ and total Ca increased markedly during the ET, the total Ca reaching 15.5 rag/100 ml in one case. However, Ca levels were normal within 30 minutes of the end of the ET. In Group III, although Ca++ levels in the donor blood were very low (0.6±0.21 mg/100 ml) the fall in Ca++ was abolished during ET in term infants. Nevertheless, the decline in Ca++ could not be prevented in the preterm infants although total Ca increased. Mechanisms of Ca homeostasis during ET are complex and it may not be possible to achieve normal Ca++ levels without excessive elevation of total Ca. However, addition of Ca to the donor blood will prevent the fluctuation in Ca++ seen with intermittent Ca administration. In addition, it appears that in vitro titration of donor blood with CaCl2 to normocalcemic levels should not be used as a means of determining the appropriate dose of Ca in ET.
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Maisels, M., Friedman, Z., Marks, K. et al. CALCIUM HOMEOSTASIS IN EXCHANGE TRANSFUSION. Pediatr Res 11, 537 (1977). https://doi.org/10.1203/00006450-197704000-01003
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DOI: https://doi.org/10.1203/00006450-197704000-01003