PRBC citrate=low Cal?

Specialties MICU

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Specializes in SICU/NeuroICU.

I recently learned that PRBCs have citrate in them to prevent clotting, and that this citrate binds to the Cal in the pts blood thereby lowering the Cal level. And in some cases this can lower the Cal to the point that hyperexcitability of cardiac muscle occurs moving to arrhythmias. I was also informed that slower infusion of PRBC helps to prevent this from happening. So I was hoping to find a place that gives specifics on rate of infusion for PRBC to help prevent this from happening. I'm thinking of the level 1 infuser in these situations where multiple units are being infused usually 1 unit per minute etc. Any info or resourses would be appreciated.

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When we are infusing multiple units of packed cells via the level 1, we usually send an ionized Ca in the process and then give some CaCl.

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Specializes in Critical Care.

Never heard of rate of infusion being a factor. My understanding of this is that it's the amount of citrate in the PRBC's that is the issue, especially when considering multiple/rapid transfusion of cells. With our open heart patients, when they require large quantity of cells secondary to bleeding, our anesthesia staff just automatically start giving Calcium chloride. If you are transfusing a patient with only one or two units of cells, I don't believe this is really an issue. I've got a new copy of AACN's Advanced Critical care nursing text and they don't mention anything about rate of transfusion impacting this issue. It did mention, however a point I had forgotten: in multiple rapid transfusion, it may be beneficial to use a blood warmer as the rapid transfusion itself can cause arrhythmias. Not exactly what you were looking for but just thought I'd mention it.

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