Effects of liver function on ionized hypocalcaemia following rapid blood transfusion

OBJECTIVE: Hypocalcaemia detrimentally affects the cardiovascular system and massive transfusion-related hypocalcaemia is particularly severe in end-stage liver disease patients undergoing liver transplantation (LT). This study, therefore, compared the severity and duration of ionized hypocalcaemia between patients with normal and impaired liver function. METHODS: Patients (n = 26 per group) were transfused at a rate of 10 ml/kg within 10 min with packed red blood cells (PRBCs) during LT (group LP) or spinal surgery (group SP), or were infused with 0.9% normal saline during spinal surgery (group SN). Serum levels of ionized calcium were assessed before (T₀), just after (T₁), and at 20 (T₂) and 60 min (T₃) after transfusion. RESULTS: Transfusion with PRBCs caused more severe ionized hypocalcaemia than 0.9% normal saline at T₁. In contrast to the faster (20 min) normalization in group SP, ionized hypocalcaemia in group LP persisted at T₃. Serum ionized calcium levels at T₃ showed correlations with vital signs, blood glucose, serum potassium, base deficit and lactate. CONCLUSION: Rapid blood transfusion caused more severe and prolonged ionized hypo calcaemia in patients with liver dysfunction than in those with normal liver function.