Association between ionised calcium and severity of postpartum haemorrhage: a retrospective cohort study

Epstein, Danny; Solomon, Neta; Korytny, Alexander; Marcusohn, Erez; Freund, Yaacov; Avrahami, Ron; Neuberger, Ami; Raz, Aeyal; Miller, Asaf

doi:10.1016/j.bja.2020.11.020

Cited by 22 publications

(17 citation statements)

References 36 publications

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“…Consistent with this finding, Morotti et al [ 19 ] reported that the presence of hypocalcemia on admission was indeed associated with the extent of bleeding in patients with intracerebral hemorrhage. This effect was also observed in patients with postpartum hemorrhage [ 20 ], and total knee arthroplasty [ 23 ]. For this reason, trials are needed to assess whether correction of hypocalcemia will lead to decreased blood loss [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 63%

“…This effect was also observed in patients with postpartum hemorrhage [ 20 ], and total knee arthroplasty [ 23 ]. For this reason, trials are needed to assess whether correction of hypocalcemia will lead to decreased blood loss [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 63%

“…Hypocalcemia is a common electrolyte disorder in hospitalized patients, nearly 56.2% in trauma patients [ 18 ]. Many studies have already investigated its harmful effect, and found that hypocalcemia was associated with more bleeding or blood transfusion in patients with intracerebral hemorrhage [ 19 ], postpartum hemorrhage [ 20 ], upper gastrointestinal bleeding [ 21 ], shocked trauma [ 22 ], and total knee arthroplasty [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Low serum calcium is associated with perioperative blood loss and transfusion rate in elderly patients with hip fracture: a retrospective study

Wang

Chen

et al. 2021

BMC Musculoskelet Disord

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Background To investigate whether hypocalcemia influenced total blood loss and transfusion rate in elderly patients with hip fracture. Methods From our hip fracture database, patients were consecutively included between January 2014 and December 2020. Serum calcium level was corrected for albumin concentration, and hypocalcaemia was defined as corrected calcium < 2.11 mmol/L. Hemoglobin and hematocrit were obtained on admission day and postoperative day, and blood transfusions were collected. According to the combination formulas of Nadler and Gross, the total blood loss of each patient was calculated. Risk factors were further analyzed by multivariate linear regression. Results A total of 583 consecutive elderly hip fracture patients were finally included (mean age 79.32 ± 8.18 years, 68.61% female). On admission, the mean serum corrected calcium level was 2.17 ± 0.14 mmol/L, and the prevalence of hypocalcemia was 33.11% (95% CI: 29.42–37.02). When comparing patients with normal calcium, hypocalcemia patients exhibited a higher blood transfusion rate (7.69% vs 16.06%, P < 0.05), and significantly larger total blood loss (607.86 ± 497.07 ml vs 719.18 ± 569.98 ml, P < 0.05). Multivariate linear regression analysis showed that male, anemia on admission, time from injury to hospital, intertrochanteric fracture, blood transfusion and hypocalcemia were independently associated with increased total blood loss (P < 0.05). Conclusion Hypocalcemia is common in elderly patients with hip fracture, and significantly associated with more total blood loss and blood transfusion. The other risk factors for increased total blood loss are male, anemia on admission, time from injury to hospital, intertrochanteric fracture, and blood transfusion. Level of evidence Level III, retrospective study.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

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Low serum calcium is associated with perioperative blood loss and transfusion rate in elderly patients with hip fracture: a retrospective study

Wang

Chen

et al. 2021

BMC Musculoskelet Disord

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“…75 Other reviews in this Special Issue discuss and compare the utility of a fixed ratio approach with a goal-directed approach and the management of hemorrhage-related coagulopathy. Other important considerations are the close monitoring of ionized calcium and magnesium, and aggressive treatment of hypocalcemia 76 and hypomagnesemia during massive transfusion.…”

Section: Monitoringmentioning

confidence: 99%

Placenta accreta spectrum disorder: updates on anesthetic and surgical management strategies

Einerson

Weiniger

2021

International Journal of Obstetric Anesthesia

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“…Studies in adults suggest an association between EH and mortality, 10 coagulopathy, 7 shock, 11 and subsequent transfusion requirements 12,13 . The association between hypocalcemia and adverse outcomes was also demonstrated in patients with gastrointestinal, postpartum, and intracranial hemorrhages 13,14 . Current guidelines recommend monitoring and correcting hypocalcemia in adult trauma patients 15,16 .…”

Section: Introductionmentioning

confidence: 99%

Early Hypocalcemia in Pediatric Major Trauma

et al. 2022

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ObjectiveEarly hypocalcemia (EH) is common in adult major trauma patients and has been associated with coagulopathy, shock, increased transfusion requirements, and mortality. The incidence of EH in pediatric severe trauma has not been investigated. We aimed to explore the incidence of EH among severely injured children.MethodsWe conducted a retrospective cohort study at a tertiary children's hospital and a level 1 pediatric trauma center. We extracted the medical records of all pediatric major trauma patients, defined as an age less than 18 years and an Injury Severity Score (ISS) greater than 15, admitted after trauma team activation from January 2010 to December 2020.The primary outcome was the presence of EH. Patients were classified into 3 groups: severe hypocalcemia (ionized calcium [iCa] <1 mmol/L), hypocalcemia (1 < iCa < 1.16 mmol/L), and normal calcium (iCa ≥1.16 mmol/L).ResultsDuring the study period, 5126 children were hospitalized because of trauma. One hundred eleven children met the inclusion criteria. The median age was 11 years (interquartile range [IQR], 4–15), and 78.4% (87) were male. The median ISS was 21 (IQR, 17–27).Hypocalcemia was found in 19.8% (22) and severe hypocalcemia in 2.7% (3) of the patients.Although not statistically significant, hypocalcemic pediatric trauma patients had higher ISS (25.5 [IQR, 17–29] vs 21 [IQR, 17–26], P = 0.39), lower Glasgow Coma Scale (11 [IQR, 3–15] vs 13 [IQR, 7–15], P = 0.24), a more prolonged hospital stay (8 days [IQR, 2–16] vs 6 days [IQR, 3–13], P = 0.36), a more frequent need for blood products (27.3% vs 20.2%, P = 0.74), and higher mortality rates (9.1% vs 1.1%, P = 0.18) compared with normocalcemic patients.ConclusionsOur data suggest that in the setting of major trauma, EH is less frequent in children than previously reported in adults. Our preliminary data suggest that pediatric patients with EH may be at risk of increased morbidity and mortality compared with children with normal admission iCa requiring further studies.

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Association between ionised calcium and severity of postpartum haemorrhage: a retrospective cohort study

Cited by 22 publications

References 36 publications

Low serum calcium is associated with perioperative blood loss and transfusion rate in elderly patients with hip fracture: a retrospective study

Low serum calcium is associated with perioperative blood loss and transfusion rate in elderly patients with hip fracture: a retrospective study

Placenta accreta spectrum disorder: updates on anesthetic and surgical management strategies

Early Hypocalcemia in Pediatric Major Trauma

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