Citrate Metabolism in Blood Transfusions and Its Relationship Due to Metabolic Alkalosis and Respiratory Acidosis

Overview

Journal Int J Clin Exp Med

Specialty General Medicine

Date 2015 Jul 2

PMID 26131288

Citations 13

Authors

Kai Li

Yuan Xu

Affiliations

Soon will be listed here.

Abstract

Metabolic alkalosis commonly results from excessive hydrochloric acid (HCl), potassium (K(+)) and water (H2O) loss from the stomach or through the urine. The plasma anion gap increases in non-hypoproteinemic metabolic alkalosis due to an increased negative charge equivalent on albumin and the free ionized calcium (Ca(++)) content of plasma decreases. The mean citrate load in all patients was 8740±7027 mg from 6937±6603 mL of transfused blood products. The citrate load was significantly higher in patients with alkalosis (9164±4870 vs. 7809±3967, P < 0.05). The estimated mean total citrate administered via blood and blood products was calculated as 43.2±34.19 mg/kilogram/day. In non-massive and frequent blood transfusions, the elevated carbon dioxide output has been shown to occur. Due to citrate metabolism causes intracellular acidosis. As a result of intracellular acidosis compensation, decompensated metabolic alkalosis + respiratory acidosis and electrolyte imbalance may develop, blood transfusions may result in certain complications.

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References

Fortunato Jr F, Kang Y, Aggarwal S, Freeman J, Pinsky M . Acid-base status during and after orthotopic liver transplantation. Transplant Proc. 1987; 19(4 Suppl 3):59-60. View

Refaai M, Blumberg N . The transfusion dilemma--weighing the known and newly proposed risks of blood transfusions against the uncertain benefits. Best Pract Res Clin Anaesthesiol. 2013; 27(1):17-35. DOI: 10.1016/j.bpa.2012.12.006. View

Brockmann J, Vaidya A, Reddy S, Friend P . Retrieval of abdominal organs for transplantation. Br J Surg. 2006; 93(2):133-46. DOI: 10.1002/bjs.5228. View

Aronson P, Giebisch G . Effects of pH on potassium: new explanations for old observations. J Am Soc Nephrol. 2011; 22(11):1981-9. PMC: 3231780. DOI: 10.1681/ASN.2011040414. View

Hardy J, de Moerloose P, Samama C . The coagulopathy of massive transfusion. Vox Sang. 2005; 89(3):123-7. DOI: 10.1111/j.1423-0410.2005.00678.x. View

YENDT E . Citrate intoxication. Can Med Assoc J. 1957; 76(2):141-4. PMC: 1823510. View

Marik P, Kussman B, Lipman J, Kraus P . Acetazolamide in the treatment of metabolic alkalosis in critically ill patients. Heart Lung. 1991; 20(5 Pt 1):455-9. View

Lin Y, Saw C, Hannach B, Goldman M . Transfusion-related acute lung injury prevention measures and their impact at Canadian Blood Services. Transfusion. 2011; 52(3):567-74. DOI: 10.1111/j.1537-2995.2011.03330.x. View

Bunker J, STETSON J, COE R, Grillo H, Murphy A . Citric acid intoxication. J Am Med Assoc. 1955; 157(16):1361-7. DOI: 10.1001/jama.1955.02950330001001. View

10.

Bell E, Strauss R, Widness J, Mahoney L, Mock D, Seward V . Randomized trial of liberal versus restrictive guidelines for red blood cell transfusion in preterm infants. Pediatrics. 2005; 115(6):1685-91. PMC: 2866196. DOI: 10.1542/peds.2004-1884. View

11.

Sutton R, Wong N, Dirks J . Effects of metabolic acidosis and alkalosis on sodium and calcium transport in the dog kidney. Kidney Int. 1979; 15(5):520-33. DOI: 10.1038/ki.1979.67. View

12.

Pochet J, Laterre P, Jadoul M, Devuyst O . Metabolic alkalosis in the intensive care unit. Acta Clin Belg. 2001; 56(1):2-9. DOI: 10.1179/acb.2001.002. View

13.

Tsinari K, Misiakos E, Lawand C, Chatzipetrou M, Lampadariou K, Neto A . Factors affecting metabolic and electrolyte changes after reperfusion in liver transplantation. Transplant Proc. 2005; 36(10):3051-6. DOI: 10.1016/j.transproceed.2004.11.098. View

14.

MURRAY N, Roberts I . Neonatal transfusion practice. Arch Dis Child Fetal Neonatal Ed. 2004; 89(2):F101-7. PMC: 1756024. DOI: 10.1136/adc.2002.019760. View

15.

Cordovi de Armas L, Jimenez Paneque R, Gala Lopez B, Rapalo Romero E, Anuez Castillo Y, Vallongo Menendez M . Rapid and homogeneous reperfusion as a risk factor for postreperfusion syndrome during orthotopic liver transplantation. Rev Bras Anestesiol. 2010; 60(2):154-61, 88-92. View

16.

Wilkes D, Gledhill N, Smyth R . Effect of acute induced metabolic alkalosis on 800-m racing time. Med Sci Sports Exerc. 1983; 15(4):277-80. DOI: 10.1249/00005768-198315040-00004. View

17.

Ozier Y, Pessione F, Samain E, Courtois F . Institutional variability in transfusion practice for liver transplantation. Anesth Analg. 2003; 97(3):671-679. DOI: 10.1213/01.ANE.0000073354.38695.7C. View

18.

Raj D, Abreo K, Zibari G . Metabolic alkalosis after orthotopic liver transplantation. Am J Transplant. 2003; 3(12):1566-9. DOI: 10.1046/j.1600-6135.2003.00253.x. View

19.

Corwin H, Parsonnet K, Gettinger A . RBC transfusion in the ICU. Is there a reason?. Chest. 1995; 108(3):767-71. DOI: 10.1378/chest.108.3.767. View

20.

Ludbrook J, WYNN V . Citrate intoxication; a clinical and experimental study. Br Med J. 1958; 2(5095):523-8. PMC: 2025780. DOI: 10.1136/bmj.2.5095.523. View