Severe citrate toxicity complicating volunteer apheresis platelet donation

A M Bell; J D L Nolen; C M Knudson; T J Raife

doi:10.1002/jca.20107

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Severe citrate toxicity complicating volunteer apheresis platelet donation

Journal article

Peer reviewed

Severe citrate toxicity complicating volunteer apheresis platelet donation

A M Bell, J D L Nolen, C M Knudson and T J Raife

Journal of clinical apheresis, Vol.22(1), pp.15-16

02/2007

DOI: 10.1002/jca.20107

PMID: 17111419

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Abstract

We report a case of severe citrate toxicity during volunteer donor apheresis platelet collection. The donor was a 40-year-old female, first-time apheresis platelet donor. Past medical history was remarkable for hypertension, hyperlipidemia, and depression. Reported medications included bumetanide, pravastatin, and paroxetine. Thirty minutes from the start of the procedure, the donor noted tingling around the mouth, hands, and feet. She then very rapidly developed acute onset of severe facial and extremity tetany. Empirical treatment with intravenous calcium gluconate was initiated, and muscle contractions slowly subsided over approximately 10 to 15 minutes. The events are consistent with a severe reaction to calcium chelation by sodium citrate anticoagulant resulting in symptomatic systemic hypocalcemia. Upon additional retrospective analysis, it was noted that bumetanide is a loop diuretic that may cause significant hypocalcemia. We conclude that careful screening for medications and underlying conditions predisposing to hypocalcemia is recommended to help prevent severe reactions due to citrate toxicity. Laboratory measurement of pre-procedure serum calcium levels in selected donors may identify cases requiring heightened vigilance. The case also illustrates the importance of maintaining preparedness for managing rare but serious reactions in volunteer apheresis blood donors.

Blood Donors

Hypocalcemia - chemically induced

Plateletpheresis - adverse effects

Humans

Adult

Female

Hypertension - drug therapy

Tetany - chemically induced

Tetany - drug therapy

Citric Acid - toxicity

Bumetanide - adverse effects

Details

Title: Subtitle: Severe citrate toxicity complicating volunteer apheresis platelet donation
Creators: A M Bell - DeGowin Blood Center, Department of Pathology, University of Iowa Carver, College of Medicine, Iowa City, IA 52242, USA
J D L Nolen
C M Knudson
T J Raife
Resource Type: Journal article
Publication Details: Journal of clinical apheresis, Vol.22(1), pp.15-16
Publisher: United States
DOI: 10.1002/jca.20107
PMID: 17111419
ISSN: 0733-2459
eISSN: 1098-1101
Language: English
Date published: 02/2007
Academic Unit: Pathology; Radiation Oncology
Record Identifier: 9984047883502771

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