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Author Notes:

saskya.byerly@jhsmiami.org; s.e.byerly@gmail.com

Conception, design, overall responsibility: KI. Data collection: SB, EW, MW. Statistical analysis: SB, SB. Analysis and interpretation: SB, SB, EW, KI. Writing the article: SB. Critical revision of the article: KI, SB, SB, MW, EB, LL, DD. Final approval of the article: KI.

We have no conflicts of interest and no sources of funding to disclose. IRB approval was obtained and informed consent was waived in compliance with institutional and national guidelines.



  • Science & Technology
  • Life Sciences & Biomedicine
  • Surgery

Transfusion-Related Hypocalcemia After Trauma


Journal Title:



Volume 44, Number 11


, Pages 3743-3750

Type of Work:

Article | Final Publisher PDF


Background: Hypocalcemia is cited as a complication of massive transfusion. However, this is not well studied as a primary outcome in trauma patients. Our primary outcome was to determine if transfusion of packed red blood cells (pRBC) was an independent predictor of severe hypocalcemia (ionized calcium ≤ 3.6 mg/dL). Methods: Retrospective, single-center study (01/2004–12/2014) including all trauma patients ≥ 18 yo presenting to the ED with an ionized calcium (iCa) level drawn. Variables extracted included demographics, interventions, outcomes, and iCa. Regression models identified independent risk factors for severe hypocalcemia (SH). Results: Seven thousand four hundred and thirty-one included subjects, 716 (9.8%) developed SH within 48 h of admission. Median age: 39 (Range: 18–102), systolic blood pressure: 131 (IQR: 114–150), median Glasgow Coma Scale (GCS): 15 (IQR: 10–15), Injury Severity Score (ISS): 14 (IQR: 9–24). SH patients were more likely to have depressed GCS (13 vs 15, p ' 0.0001), hypotension (23.2% vs 5.1%, p ' 0.0001) and tachycardia (57.0% vs 41.9%, p ' 0.0001) compared to non-SH patients. They also had higher emergency operative rate (71.8% vs 29%, p ' 0.0001) and higher blood administration prior to minimum iCa [pRBC: (8 vs 0, p ' 0.0001), FFP: (4 vs 0, p ' 0.0001), platelet: (1 vs 0, p ' 0.0001)]. Multivariable analysis revealed penetrating mechanism (AOR: 1.706), increased ISS (AOR: 1.029), and higher pRBC (AOR: 1.343) or FFP administered (AOR: 1.097) were independent predictors of SH. SH was an independent predictor of mortality (AOR: 2.658). Regression analysis identified a significantly higher risk of SH at pRBC + FFP administration of 4 units (AOR: 18.706, AUC:. 897 (0.884–0.909). Conclusion: Transfusion of pRBC is an independent predictor of SH and is associated with increased mortality. The predicted probability of SH increases as pRBC + FFP administration increases.

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© 2020, Société Internationale de Chirurgie.

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