What complication arises from massive blood transfusion related to citrate anticoagulant?

Massive blood transfusions often involve the use of citrate as an anticoagulant to prevent clotting in the donated blood. Citrate works by chelating calcium ions in the blood, which temporarily reduces the levels of free calcium. When a patient receives a large volume of blood products, the citrate can lead to a significant drop in ionized calcium, resulting in hypocalcemia.

Hypocalcemia during or after a massive transfusion can present with symptoms such as tingling, muscle spasms, or even cardiac issues. It's crucial for clinicians to monitor calcium levels and be prepared to administer calcium supplements if necessary, particularly when large volumes of blood are transfused in a short period.

While other complications can arise from massive transfusions, such as hyperkalemia due to the release of potassium from stored red blood cells or hypomagnesemia from the clearance of magnesium in conjunction with citrate, the direct mechanism of citrate-induced hypocalcemia is the most relevant complication in this scenario. Increased ESR (erythrocyte sedimentation rate) is not directly related to citrate infusion and does not occur as a consequence of the anticoagulant effect.