| Increased risk of citrate reactions in patients with multiple myeloma during peripheral blood stem cell leukapheresis. | |
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MedLine Citation:
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PMID: 20818713 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The citrate based anticoagulant ACD is commonly used in apheresis procedures. Due to its ability to decrease ionized calcium, citrate may cause unpleasant symptoms, such as paresthesias and muscle cramps, in patients undergoing therapeutic and donor apheresis. We noticed that patients with multiple myeloma (MM) undergoing autologous stem cell leukapheresis appeared to have more citrate reactions when compared to other patients undergoing the same procedure. A retrospective chart review was performed to evaluate 139 (of 151) consecutive patients with MM, amyloidosis, hematological and solid malignancies who had autologous peripheral blood stem cell collection between January 2007 and February 2008. Citrate reactions, ranging from mild (e.g., perioral tingling and parasthesias) to severe (e.g., nausea/vomiting and muscle cramps) were noted for 35 patients. Twenty-three of 63 patients with MM had documented citrate reactions, which was significantly higher than those with other hematological and solid malignancies (37% vs. 20%; P < 0.05, Relative Risk (RR) = 1.9). The severities of citrate reactions were the same in both groups; approximately 50% of patients in each group received i.v. calcium gluconate for treatment of hypocalcemia. No correlation between bisphosphonate therapy and citrate reactions were noted in our study group. Examination of available laboratory values related to calcium homeostasis, liver, and renal function failed to reveal a mechanism for the increase in citrate reactions observed. In summary, this single institution retrospective study indicates that patients with MM are more sensitive to citrate-induced hypocalcemia during leukapheresis when compared to patients with other hematological and solid malignancies. Strategies for decreasing citrate reactions (e.g., supplemental calcium and slowing return rates) should be considered for patient safety and comfort, especially in the MM population, on a prophylactic rather than reactive basis. |
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Authors:
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Jill Adamski; Adrienne Carruth Griffin; Christa Eisenmann; Michael C Milone; Bruce S Sachais |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of clinical apheresis Volume: 25 ISSN: 1098-1101 ISO Abbreviation: J Clin Apher Publication Date: 2010 |
Date Detail:
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Created Date: 2010-09-06 Completed Date: 2011-01-06 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8216305 Medline TA: J Clin Apher Country: United States |
Other Details:
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Languages: eng Pagination: 188-94 Citation Subset: IM |
Affiliation:
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Department of Pathology and Laboratory Medicine, Division of Transfusion Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Calcium Gluconate
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therapeutic use Citric Acid / adverse effects* Hematologic Neoplasms / complications, therapy Humans Hypocalcemia / chemically induced*, drug therapy Kidney Function Tests Leukapheresis / methods* Liver Function Tests Multiple Myeloma / complications, therapy* Neoplasms / complications, therapy Peripheral Blood Stem Cell Transplantation / methods Retrospective Studies Transplantation, Autologous |
| Chemical | |
Reg. No./Substance:
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299-28-5/Calcium Gluconate; 77-92-9/Citric Acid |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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