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Abstract：
Massive transfusion protocols (MTPs) are associated with severe hypocalcemia, contributing to coagulopathy and mortality in severely injured patients. Severity of hypocalcemia following massive transfusion activation and appropriate treatment strategies remain undefined.
This was a retrospective study of all MTP activations in adult trauma patients at a Level 1 trauma center between August 2016 and September 2017. Units of blood products transfused, ionized calcium levels, and amount of calcium supplementation administered were recorded. Primary outcomes were ionized calcium levels and the incidence of severe ionized hypocalcemia (iCa ≤1.0 mmol/L) in relation to the volume of blood products transfused.
Seventy-one patients had an MTP activated during the study period. The median amount of packed red blood cells (PRBCs) transfused was 10 units (range 1-52). A total of 42 (59.1%) patients had periods of severe hypocalcemia. Patients receiving 13 or more units of PRBC had a greater prevalence of hypocalcemia with 83.3% having at least one measured ionized calcium ≤1.0 mmoL/L (p = .001). The number of ionized calcium levels checked and the amount of supplemental calcium given in patients who experienced hypocalcemia varied considerably.
Severe hypocalcemia commonly occurs during MTP activations and correlates with the number of packed red blood cells transfused. Monitoring of ionized calcium and amount of calcium supplementation administered is widely variable. Standardized protocols for recognition and management of severe hypocalcemia during massive transfusions may improve outcomes.
This was a retrospective study of all MTP activations in adult trauma patients at a Level 1 trauma center between August 2016 and September 2017. Units of blood products transfused, ionized calcium levels, and amount of calcium supplementation administered were recorded. Primary outcomes were ionized calcium levels and the incidence of severe ionized hypocalcemia (iCa ≤1.0 mmol/L) in relation to the volume of blood products transfused.
Seventy-one patients had an MTP activated during the study period. The median amount of packed red blood cells (PRBCs) transfused was 10 units (range 1-52). A total of 42 (59.1%) patients had periods of severe hypocalcemia. Patients receiving 13 or more units of PRBC had a greater prevalence of hypocalcemia with 83.3% having at least one measured ionized calcium ≤1.0 mmoL/L (p = .001). The number of ionized calcium levels checked and the amount of supplemental calcium given in patients who experienced hypocalcemia varied considerably.
Severe hypocalcemia commonly occurs during MTP activations and correlates with the number of packed red blood cells transfused. Monitoring of ionized calcium and amount of calcium supplementation administered is widely variable. Standardized protocols for recognition and management of severe hypocalcemia during massive transfusions may improve outcomes.
摘要：
大量输血方案（MTP）与严重的低钙血症有关，导致严重受伤患者的凝血障碍和死亡率。大量输血激活后低钙血症的严重程度和适当的治疗策略仍未定义。
这是一项回顾性研究，研究了2016年8月至2017年9月在1级创伤中心的成年创伤患者的所有MTP激活情况。单位输血的血液制品，钙离子水平，并记录钙补充剂的给药量。主要结果是离子钙水平和严重离子低钙血症（iCa≤1.0mmol/L）的发生率与输入的血液制品量的关系。
71例患者在研究期间激活了MTP。输注的浓缩红细胞（PRBC）的中位数为10个单位（范围1-52）。共有42例（59.1％）患者患有严重的低钙血症。接受13个或更多单位PRBC的患者的低钙血症患病率更高，其中83.3％的患者至少有一个测量的离子钙≤1.0mmoL/L（p=.001）。在经历低钙血症的患者中，所检查的离子钙水平的数量和补充钙的量差异很大。
严重的低钙血症通常发生在MTP激活期间，并与输注的红细胞聚集数相关。离子钙的监测和所施用的钙补充剂的量是广泛可变的。在大量输血期间识别和管理严重低钙血症的标准化方案可能会改善预后。
这是一项回顾性研究，研究了2016年8月至2017年9月在1级创伤中心的成年创伤患者的所有MTP激活情况。单位输血的血液制品，钙离子水平，并记录钙补充剂的给药量。主要结果是离子钙水平和严重离子低钙血症（iCa≤1.0mmol/L）的发生率与输入的血液制品量的关系。
71例患者在研究期间激活了MTP。输注的浓缩红细胞（PRBC）的中位数为10个单位（范围1-52）。共有42例（59.1％）患者患有严重的低钙血症。接受13个或更多单位PRBC的患者的低钙血症患病率更高，其中83.3％的患者至少有一个测量的离子钙≤1.0mmoL/L（p=.001）。在经历低钙血症的患者中，所检查的离子钙水平的数量和补充钙的量差异很大。
严重的低钙血症通常发生在MTP激活期间，并与输注的红细胞聚集数相关。离子钙的监测和所施用的钙补充剂的量是广泛可变的。在大量输血期间识别和管理严重低钙血症的标准化方案可能会改善预后。
