Application of continuous blood purification with citrate anti-coagulant in patients at high risk of bleeding

Objective: To evaluate the efficiency of continuous blood purification (CPB) with citrate anticoagulant in patients at high risk of bleeding. Methods: 32 patients with high risk for bleeding were treated with citrate-based pre-dilution. They were randomly divided into group A (16 cases) and B (16 cases). Blood flow rate was 200 mL/min in group A, and 250 mL/min in group B. Replacement solution was infused at 2 000 mL/hr with citrate 13.3 mmol/L in group A and 4 000 mL/hr with citrate 7 mmol/L in group B. Calcium gluconate was infused with a separate line. Calcium infusion rate was adjusted according to serum ionized calcium. Serum total calcium, ionized calcium, whole blood activated clotting time (WBACT) and acid-base changes were monitored pre and post-CPB. Complaints of the patients during treatment and each filter were recorded. Results: 32 patients had undergone CPB 112 times, The total treatment time was 1 238.3 h. The levels of WBACT of pre-filter altered little during CPB. The levels of WBACT of post-filter were significantly prolonged compared with pre-filter at 2 h, 4 h, 6 h in group A and B, respectively. Total serum calcium and ionized calcium showed subtle changes during and post-CPB compared with that during pre-CPB. No metabolic alkalosis was found post-CPB. No bleeding episodes and serious side effects were found in the whole duration of 1238.3 hours of CPB. Conclusion: Citrate-based replacement solution at high and low infusion rates during CPB can obtain effective anticoagulation for patients with high risk of bleeding.