Shock Citrate

Citrate shock is an emergency condition resulting from the transfusion of a large amount of blood with a citrate-containing solution or the simultaneous administration of sodium citrate and albumin. The relevance of the problem is due to the fact that among all solutions used in clinical practice for the preparation of blood components, citrates are the most used (about 66%).

Shock of citrate origin is recorded in 29% of all emergency conditions in patients receiving blood components and biological drugs for various diseases. Based on the results of monitoring blood component transfusions in Russia, it was found that the main groups of patients who had the possibility of developing the “citrate reaction” syndrome were children of different ages and men, and among the most common causes were lesions of the gastrointestinal tract and extensive trauma.

Citrate-type shock is a rare complication of citrate plasma transfusion. It is one of two forms of hemolytic reflux, along with citrate-bicarbonate crisis. A citrate crisis results in the release of significant amounts of bicarbonate into the bloodstream. This usually occurs with very high doses of citrate. The term was coined between the 1930s and 1940s and has a meaning similar to that of "citrus shock", coined in 1726 to describe an acute reaction to citrus acid that manifests as cerebrovascular thrombosis, cardiac arrhythmia and surges in blood pressure. Characterized by chest pain, chest pain and profuse vomiting. Currently, citrated blood is used less frequently than before, mainly due to the fact that there are fewer components in the serum that affect the function of the blood coagulation apparatus, the concentration of fibrinogen in plasma decreases, and the quality of the blood deteriorates. Now the transfusion of ABO or Rhesus incompatible blood is strictly prohibited; the reason was precisely the citrates used in the blood product production system. It cannot be said that the state of shock completely appeared with the advent of these drugs. There have been no reliable reports of citrate shock resulting from the use of citrite EDTA in blood or plasma transfusions. These two components are usually used together in finished products for compatibility. Sodium citrate and aluminum citrate were released in the 30s by a pharmaceutical company from the United States of America, but this happened not because such technology was used in the production of preservatives and blood components for the first time, but because a group of enthusiasts decided to offer a product that would help reduce material costs for training and management, and improve the quality of existing substances. So, one substance from the group of citrate compounds was selected for use as the main stabilizer of biological fluid. During its history, sodium citrate as a major component of preservatives in various sectors of society began to be used as a pH stabilizer in some surgical anesthetics such as sodium ti solution