Abstract | RATIONALE: Protocols for regional citrate anticoagulation with the hypertonic 4% trisodium citrate solution have been recently described as an anticoagulation strategy during membrane therapeutic plasma exchange (mTPE). The effect of citrate in the patient's systemic hemostasis is negligible, thus regional citrate anticoagulation application is advantageous in circumstances in which heparin-based protocols are deemed unsafe for patients with a high risk of bleeding. The downsides of using hypertonic citrate solutions are mainly hypocalcemia and hypernatremia that ultimately can cause adverse clinical events. PRESENTING CONCERNS OF THE PATIENT: DIAGNOSES: INTERVENTIONS: Herein, we describe a case series of 12 consecutive mTPE treatments in 2 different patients using regional 4% trisodium citrate anticoagulation. OUTCOMES: All the sessions were uneventful, presented only minor electrolyte imbalances, and were effectively completed without early interruptions due to clotting of the plasmafilter. TEACHING POINTS: In our 2 cases, extracorporeal regional citrate anticoagulation was successful in optimizing plasmafilter patency without bleeding events in 2 high-risk patients using established protocols for the citrate and calcium infusions.
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Authors | Thiago Reis, Geraldo Rubens Ramos de Freitas, Fábio Reis, Maria Letícia Cascelli de Azevedo, Priscila Dias, Diêgo Fernando Figueiredo Santos, Rodrigo Alfredo Vivanco Vergara, Luca Sgarabotto, Evandro Reis da Silva Filho, Claudio Ronco |
Journal | Canadian journal of kidney health and disease
(Can J Kidney Health Dis)
Vol. 8
Pg. 20543581211054736
( 2021)
ISSN: 2054-3581 [Print] England |
PMID | 34777842
(Publication Type: Journal Article)
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Copyright | © The Author(s) 2021. |