The effect on serum ionic magnesium of exchange transfusion with citrated as opposed to heparinized blood.

Serum Mg++ levels before, during, and after replacement transfusion were determined in 20 newborn infants. In 10 infants exchanged with acid-citrate-dextrose (ACD) blood, the level fell from 1.75 +/- 0.16 mEq./l. to 0.99 +/- 0.16 mEq./l. By contrast, levels in 10 infants exchanged with two types of heparinized blood were unchanged: the pre-exchange values were 1.59 +/- 0.11, and the postexchange levels were 1.59 +/- 0.08 mEq./l. Mean values for donor bloods were 0.42 +/- 0.07 mEq./l. with ACD blood, and 1.45 +/- 0.03 mEq./l. with heparinized blood. In vitro studies involving the addition of known amounts of citrate to standard Mg++ solutions demonstrated that the citrate caused a reduction of ionic magnesium. It is proposed that the fall in serum Mg++ when ACD blood is used for exchange transfusion is the combined result of Mg++ binding by the citrate, and the dilution effect of the relatively large proportion of anticoagulant to blood (1:3) used with the ACD mixture.