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Citrate Toxicity During Massive Blood Transfusion

1988; Elsevier BV; Volume: 2; Issue: 2 Linguagem: Inglês

10.1016/s0887-7963(88)70035-8

1532-9496

Sunny Dzik, Scott A. Kirkley,

Trauma, Hemostasis, Coagulopathy, Resuscitation

THE USE OF sodium citrate as the blood anticoagulant for transfusion science dates from 1914 to 1915 and the almost simultaneous publication of the work of four independent investigators. Articles from Hustin,l Agote,2 Weil,3 and Lewisohn,4 published between May 1914 and January 1915, each reported the successful use of citrated blood for human transfusion. Because citrate was known to be toxic to animals, Lewisohn carefully titrated the minimum concentration of citrate required to prevent clotting. Despite the demonstration by Weil that citrated blood could be stored for several days and still be effective,3 and the discovery by Rous and TurnerS that citrated blood supplemented by dextrose was capable of more prolonged storage, citrated blood was not quickly accepted by the general medical community. Though used with success in limited trials on the battlefield in World War 1,6 transfusions with citrated blood were often associated with chills and fever which were incorrectly attributed to the citrate. Febrile reactions were so common with citrated blood that during the 1920s most transfusions consisted of the rapid transfers of nonanticoagulated whole blood, and the use of stored citrated blood did not become commonplace until the mid-1930s. 7 While improvements in transfusion technology and the establishment of blood banks made the administration of blood a standard procedure in the operating room, blood usage was generally limited to a few units for any given patient. Advances in knowledge of the biochemistry of citrate and calcium led to an improved understanding of their interaction as well as the relationship of serum ionized Ca + + to total serum calcium. The development of citrate toxicity due to acute hypocalcemia was demonstrated in dogs as early as 1944. After Wodd War II surgical techniques of increas-