The Toxic Effects of Citrated Blood and the Search for a Suitable Substitute for Use in Cardiac Surgery

Cookson, Brian A.; Costas-Durieux, Jaime; Bailey, Charles P.

doi:10.1097/00000658-195404000-00006

Cited by 26 publications

(4 citation statements)

References 2 publications

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“…First, a number of reports have shown that the low survival rate of dogs bled to shock levels and reinfused with citrated blood is markedly improved if calcium is given or if heparin is used instead of citrate.19 7. 9 Second, experiments in humans have proven that citrate has a markedly depressive effect on the circulation,s and a few case reports attest to the fact that cardiac standstill after massive transfusion of citrated blood can be corrected by injection of calcium.2. 14 Fear of citrate toxicity has led most physicians to administer supplemental calcium when multiple units of citrated blood are infused in rapid succession.…”

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confidence: 99%

Calcium Ion Activity During Rapid Exchange Transfusion with Citrated Blood

et al. 1971

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Measurement of ionized calcium levels by the technic of Soulier during massive transfusion of ACD blood supplemented with various quantities of calcium led to the apparently erroneous conclusion that ionized calcium levels would rise in the recipient when each unit was supplemented with 0.6 g CaCl2, the quantity which restores normal ionized calcium levels in vitro. Measurement of ionized calcium activity with the Orion electrode indicates that this ratio of CaCl2 will maintain an approximately normal ionized calcium level in dog recipients if it is infused simultaneously with the blood. Based on this information, it appears reasonable to assume that heparinized ACD blood, recalcified with 0.6 g CaCl2 per unit, may be used to prime the extracorporeal circuit for open heart surgery with the confidence that it will not alter the ionized calcium activity of the patient's blood. Addition of calcium to the circulation following administration of ACD blood causes a sharp rise and then a fall in the recipient's level of ionized calcium. Further studies in a variety of situations are required before final guidelines can be formulated for supplementation of ACD blood with calcium in massive transfusion.

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Calcium Ion Activity During Rapid Exchange Transfusion with Citrated Blood

et al. 1971

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“…Cookson and co-workers have suggested that hypothermia which has been utilized in vascular surgery may compound the hazard by further reduction of ability to utilize large amounts of administered citrate (Cookson, Costas-Durieux and Bailey, 1954). Anoxia per se may also induce hypercitricemia (Hallman and Forsander, 1952).…”

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confidence: 99%

Hypercitricemia in Human Cancer. Factors concerned in Pathogenesis and Treatment

Lemon¹,

Mueller²,

Looney³

et al. 1960

Br J Cancer

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PATIENTS with leukemia, metastatic carcinoma and sarcoma possess altered carbohydrate metabolism as shown by reduced glucose tolerance (Marks and Bishop, 1957), and elevated resting venous lactic acid (Cori and Cori, 1925). Enzymes concerned in tissue glycolysis are often increased in activity in serum during neoplastic disease progression, including phosphohexose isomerase (Bodansky, 1954b), aldolase (Sibley Fleischer and Higgins, 1955), and lactic dehydrogenase (Hill and Levi, 1954). Acid phosphomonoesterases hydrolyzing three-carbon substrates produced during glycolysis are also increased in activity in venous blood from patients with breast and prostate cancer (Reynolds, Lemon and Byrnes, 1956

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“…Since the introduction of citrate as an an ticoagulant to preserve blood for transfusion, several reports have documented hypoten sion combined with signs of depressed myo cardial function following rapid citrate blood transfusions [3,7,9,13], Enhancement of these adverse effects has been shown with both physiological and pharmacological in terferences such as hypotension [24], experi mental caval occlusion [6], hyperkaliemia [14], hypothermia [12], total sympathetic block [3], hypoxia and acidosis [7], and betaadrenergic blockade [9]. In addition we have observed a fairly large negative inotropic ef fect in an acute canine surgical preparation needing rapid blood transfusion when blood containing citrate was transfused.…”

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confidence: 99%

Peroperative Myocardial Ischemia and Citrate Administration: Cardiovascular Adaptability in Conscious Dogs

Dumont

Stanley

Chartrand³

1985

Eur Surg Res

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Since the hemodynamic response elicited by the administration of citrate is sensitive to alterations in the baseline cardiovascular status, we have investigated the consequences of peroperative myocardial ischemia upon this hemodynamic response. 19 dogs equipped with an electromagnetic flow probe positioned around the ascending aorta served as control (group I). 16 dogs were equipped similarly and in addition submitted to 1 h of myocardial ischemia combined with topical cardiac hypothermia (group II). Hemodynamic studies were carried out 3 h postoperatively and then daily for 1 month, before and during rapid intravenous administration of citrate. From baseline hemodynamic data, cardiac failure was only evident 3 h postoperatively in group II. Transient hypotension and myocardial depression resulted from administration of citrate in both groups with no evidence of peripheral vasodilation. Hypotension and the negative inotropic response were more pronounced in the presence of cardiac failure following peroperative myocardial ischemia. Long-term studies indicate that global myocardial ischemia did not interfere with the cardiovascular adaptability to this pharmacologic interference.

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The Toxic Effects of Citrated Blood and the Search for a Suitable Substitute for Use in Cardiac Surgery

Cited by 26 publications

References 2 publications

Calcium Ion Activity During Rapid Exchange Transfusion with Citrated Blood

Calcium Ion Activity During Rapid Exchange Transfusion with Citrated Blood

Hypercitricemia in Human Cancer. Factors concerned in Pathogenesis and Treatment

Peroperative Myocardial Ischemia and Citrate Administration: Cardiovascular Adaptability in Conscious Dogs

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