Role of Oral versus Intravenous Calcium Supplementation in Plateletpheresis Donors: A Prospective Observational Study

Abstract

Introduction: Single Donor Platelets (SDP) are in high demand and are the preferred choice for patients requiring recurrent platelet transfusions. Citrate, being the anticoagulant of choice, may result in symptoms of citrate toxicity due to repeated frequent donations or increased procedure time. Aim: The present study aimed to evaluate the role of prophylactic calcium supplementation (oral vs intravenous) on plateletpheresis donors and correlate their effects with adverse donor reactions (citrate toxicity). Materials and Methods: This prospective observational study on plateletpheresis donors was conducted for a period of one year in the Department of Transfusion Medicine at Government Royapettah Hospital, The Tamil Nadu Dr. MGR Medical University, Chennai, India. It included 63 plateletpheresis donors divided into two groups based on random allocation-the Oral calcium supplementation group (n=32 donors) and the intravenous calcium supplementation group (n=31 donors). For both groups, their biochemical parameters (serum calcium, serum ionised calcium, serum magnesium) were measured before and within 30 minutes after the plateletpheresis procedure. The parameters were analysed for symptoms of citrate toxicity. Analysis was carried out using Statistical Package for Social Sciences (SPSS) Software version 20.0, and paired t-test was used for analysing biochemical parameters. Results: A statistically significant decline in serum ionised calcium levels (1.17±0.09 vs 1.10±0.11) (preprocedure level vs postprocedure level) was observed in the oral calcium supplementation group compared to the intravenous calcium supplementation group (1.07±0.25 vs 1.11±0.14). The authors observed a decline in the mean levels of serum calcium in both the oral calcium group (10.33±1.62 vs 9.88±1.00) and the intravenous calcium group (10.31±1.33 vs 10.21±0.88). Furthermore, the authors observed a decline in mean serum magnesium levels in the oral calcium group (2.13±0.30 vs 2.07±0.24) with no difference observed in the intravenous calcium group (2.14±0.22 vs 2.14±0.14). Mild citrate toxicity symptoms in the form of tingling sensation and perioral paraesthesia were observed in 26 out of 32 donors in the oral calcium group, whereas no symptoms were recorded in the intravenous calcium group. Conclusion: Prophylactic intravenous calcium supplementation resulted in better bioavailability of serum ionised calcium levels with no citrate toxicity symptoms compared to oral calcium supplementation. This results in better retention of plateletpheresis donors, enabling smooth and comfortable collection of a high concentration of platelets from a single donor. However, it is imperative to conduct more studies with a larger number of plateletpheresis donors to observe donor adverse reactions specific to the population.