Hypocalcemia and Massive Blood Transfusions: A Pilot Study in a Level I Trauma Center

Abstract

Trauma is a leading cause of death in the United States, and uncontrolled hemorrhage is often the primary cause of mortality. Massive transfusions provide lifesaving treatment for the bleeding trauma patient; yet, this is not a benign intervention. Calcium levels can be significantly decreased with rapidly transfused blood products due to the citrate preservative that is added. Citrate binds to the patient's endogenous calcium when blood products are administered, rendering calcium inactive. As a result, undesirable physiological effects can occur. Although there is a plethora of evidence reporting the negative effects of hypocalcemia during resuscitation, the research for standardization of calcium monitoring and replacement during a massive transfusion event is less robust. Consequently, monitoring and replacement of this vital electrolyte are often overlooked. Trauma department employees at an urban academic hospital were given a pretest to assess their knowledge of calcium monitoring and replacement during a massive transfusion. On the basis of test results and a need for staff education, a short, animated video was designed and distributed for viewing. Following the educational video, a posttest was administered and yielded higher scores when compared with the pretest (p = .001). Lack of knowledge and national standards may be root causes for hypocalcemia. Educational interventions such as innovative, brief videos can be effective for enhancing staff members' knowledge and improving patient care.

Massive transfusions and severe hypocalcemia: An opportunity for monitoring and supplementation guidelines

“…These studies emphasize that hypocalcemia commonly occurs in trauma patients who have received blood products and contributes to coagulopathy, increased need for additional blood products, and increased mortality. A recent pilot study from the University of Pennsylvania emphasized that significant knowledge gaps exist with bedside providers to recognize and treat hypocalcemia in trauma patients 21 . Their study comments on the lack of standardized calcium assessments and supplementation strategies following MTP contributing to hypocalcemic events.…”

“…A recent pilot study from the University of Pennsylvania emphasized that significant knowledge gaps exist with bedside providers to recognize and treat hypocalcemia in trauma patients. 21 Their study comments on the lack of standardized calcium assessments and supplementation strategies following MTP contributing to hypocalcemic events. This literature highlights the need to establish uniform definitions and algorithms for the prevention and treatment of severe hypocalcemia.…”

Effect of Intra- and Post-Operative Fluid and Blood Volume on Postoperative Pulmonary Edema in Patients with Intraoperative Massive Bleeding

“…This increases the risk of developing transfusion-related acute lung injury and circulatory overload [ 45 , 46 ]. Acidosis and hypocalcemia caused by blood transfusions can affect heart contractility and can cause pulmonary edema [ 47 , 48 , 49 ]. However, correctable abnormalities may not last long because the patient is closely monitored intraoperatively for abnormalities such as anemia [ 50 ] as well as for volume status [ 51 ], body temperature, electrolytes, and coagulation defects.…”

Comparison of the effect of open-box versus closed-box prostheses on blood loss following total knee arthroplasty: a meta-analysis

“…A study done in Saudi Arabia calculated the incidence rate of blood transfusion following unilateral TKA to be 27.7%, while bilateral TKA was 73.7% 6 . It is important to note that transfusions carry a significant risk of transmission of blood-borne infections 7 , febrile reactions 8 , allergic reactions 9 , volume overload 10 , and alteration of electrolytes 11 . Due to the high rates of transfusion following TKA and its potential complications, multiple preventive measures have been developed to decrease the rates of transfusions, including preoperative haemoglobin optimization, femoral canal obturation, and tranexamic acid administration.…”