Novel blood product transfusion regimen to prevent clotting and citrate accumulation during continuous renal replacement therapy with regional citrate anticoagulation in children
Introduce a novel protocol to prevent clotting and citrate accumulation (CA) from blood product transfusion (BPT) during continuous renal replacement therapy (CRRT) with regional citrate anticoagulation (RCA) in children. We prospectively compared fresh frozen plasma (FFP) and platelet transfusions...
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Published in | Frontiers in pediatrics Vol. 11; p. 1086420 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Switzerland
Frontiers Media S.A
15.06.2023
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Subjects | |
Online Access | Get full text |
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Summary: | Introduce a novel protocol to prevent clotting and citrate accumulation (CA) from blood product transfusion (BPT) during continuous renal replacement therapy (CRRT) with regional citrate anticoagulation (RCA) in children.
We prospectively compared fresh frozen plasma (FFP) and platelet transfusions between the two BPT protocols, direct transfusion protocol (DTP) and partial replacement of citrate transfusion protocol (PRCTP), in terms of the risks of clotting, citric accumulation (CA), and hypocalcemia. For DTP, blood products were directly transfused without any adjustment to the original RCA-CRRT regimen. For PRCTP, the blood products were infused into the CRRT circulation near the sodium citrate infusion point, and the dosage of 4% sodium citrate was reduced depending on the dosage of sodium citrate in the blood products. Basic information and clinical data were recorded for all children. Heart rate, blood pressure, ionized calcium (iCa) and various pressure parameters were recorded before, during and after BPT, as well as coagulation indicators, electrolytes, and blood cell counts before and after BPT.
Twenty-six children received 44 PRCTPs and 15 children received 20 DTPs. The two groups had similar
ionized calcium (iCa) concentrations (PRCTP: 0.33 ± 0.06 mmol/L, DTP: 0.31 ± 0.04 mmol/L), total filter lifespan (PRCTP: 49.33 ± 18.58, DTP: 50.65 ± 13.57 h), and filter lifespan after BPT (PRCTP: 25.31 ± 13.87, DTP: 23.39 ± 11.34 h). There was no visible filter clotting during BPT in any of the two groups. The two groups had no significant differences in arterial pressure, venous pressure, and transmembrane pressure before, during, or after BPT. Neither treatment led to significant decreases in WBC, RBC, or hemoglobin. The platelet transfusion group and the FFP group each had no significant decrease in platelets, and no significant increases in PT, APTT, and D-dimer. The most clinically significant changes were in the DTP group, in which the ratio of total calcium to ionized calcium (T/iCa) increased from 2.06 ± 0.19 to 2.52 ± 0.35, the percentage of patients with T/iCa above 2.5 increased from 5.0% to 45%, and the level of
iCa increased from 1.02 ± 0.11 to 1.06 ± 0.09 mmol/L (all
< 0.05). Changes in these three indicators were not significant in the PRCTP group.
Neither protocol was associated with filter clotting during RCA-CRRT. However, PRCTP was superior to DTP because it did not increase the risk of CA and hypocalcemia. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Edited by: Monica Vavilala, University of Washington, United States Abbreviations DTP, direct transfusion protocol; PRCTP, partial replacement of citrate transfusion protocol; CA, citric accumulation; BPT, blood product transfusion; CRRT, continuous renal replacement therapy; iCa, ionized calcium; T/iCa, total calcium to ionized calcium; PT, prothrombin time; APTT, activated partial thromboplastin time; SHA, systemic heparin anticoagulation; KDIGO, kidney disease improving global outcomes; FFP, fresh frozen plasma. These authors have contributed equally to this work Reviewed by: Emanuele Buccione, Azienda USL di Pescara, Italy Gianina Flocco, Cleveland Clinic, United States |
ISSN: | 2296-2360 2296-2360 |
DOI: | 10.3389/fped.2023.1086420 |