As the volume of blood processed in harvesting peripheral blood stem cells (PBSCH) for autologous stem cell transplantation increases, clinical symptoms associated with hypocalcemia can occur. In this study, we evaluated several calcium supplementation methods for the prevention of hypocalcemia during PBSCH apheresis.
Ionized calcium (ICa) level in peripheral blood was measured in 35 procedures in 19 patients. ICa in patients with hypocalcemic symptoms was lower than that in those without symptoms, but the difference was significant only at 120 minutes of apheresis. Continuous injection of calcium during the procedure kept ICa almost within the normal range in three patients. In six patients who took an isotonic drink per os at the time symptoms appeared, ICa value increased within 3 minutes after intake.
As hypocalcemia-associated symptoms mostly appeared at 120 minutes after the start of the procedure, prophylactic treatment is not difficult. Further, continuous injection of pharmaceutical calcium into a venous port with measurement of ICa is an excellent method for infants and patients unable to take isotonic drinks orally. Oral administration of an isotonic drink is the most effective way to control ICa level, even though these drinks have a low Ca content.
