Clinical observation of regional citrate anticoagulation in pediatric plasma exchange
10.3760/cma.j.issn.1671-0282.2025.06.009
- VernacularTitle:局部枸橼酸抗凝在儿童血浆置换中的应用观察
- Author:
Wei DANG
1
;
Fan ZHANG
;
Yunxia LI
;
Jie CHEN
;
Xia LIN
;
Sufang ZHANG
;
Weifeng LU
Author Information
1. 济南市儿童医院儿童重症监护病房，济南 250022
- Keywords:
Regional citrate anticoagulation;
Plasma exchange;
Pediatrics;
Metabolic alkalosis;
Citrate accumulation
- From:
Chinese Journal of Emergency Medicine
2025;34(6):795-802
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the efficacy and safety of regional citrate anticoagulation (RCA) during plasma exchange (PE) in pediatric patients.Methods:We conducted a retrospective analysis of 12 critically ill children admitted to the Pediatric Intensive Care Unit (PICU) of Jinan Children's Hospital, who underwent 28 PE sessions with RCA between December 2023 and August 2024. Clinical records were reviewed to assess bleeding events, extracorporeal circuit performance, and changes in arterial blood gas parameters, serum total calcium (Ca tot), and activated clotting time before and after treatment. Results:No patients exhibited signs of increased bleeding. In one case, the procedure was discontinued prematurely due to elevated venous pressure. A significant decrease in ionized calcium (Ca ion) was observed 0.5 hours post-treatment. At the end of PE, pH, HCO 3?, base excess (BE), lactate, PaCO 2, Ca tot, and Na + levels increased, while K + and Ca ion levels decreased, with all changes being statistically significant. Four hours post-treatment, pH, HCO 3?, BE, PaCO 2, and Na + remained elevated, whereas Ca ion, lactate, and K + returned to baseline. By 12–15 hours post-treatment, all parameters—including pH, HCO 3?, BE, PaCO 2, Na +, K +, Ca ion, and lactate—had normalized, showing no significant differences from pre-treatment levels. Conclusions:RCA provides effective extracorporeal anticoagulation during pediatric PE without increasing bleeding risk. However, metabolic complications—primarily metabolic alkalosis—are common. These disturbances typically resolve spontaneously and do not lead to severe adverse events. While no ideal anticoagulant for PE has yet been established, RCA remains a safe and effective option, particularly for pediatric patients at higher risk of bleeding.
