Abstract
This brief review provides an overview of the role of citrate-containing preservatives in the processing and storage of blood components for transfusion, as well as the physiologic impact of citrate ion on transfusion recipients. Correction of hypocalcemia and other toxicities arising from citrate infusion is being increasingly appreciated in trauma and damage control resuscitation; a review of current practice guidelines regarding the identification and correction of hypocalcemia and citrate toxicity in emergency scenarios is provided. Lack of awareness about the citrate content in any given blood product likely impairs prompt and accurate reversal of hypocalcemia; however, such data is limited in literature and is generally unavailable to the transfusing provider. We offer calculated citrate levels in common blood products, and emphasize that plasma-rich product such as fresh frozen plasma and apheresis platelets contains relatively greater amounts of citrate than packed red blood cells, meriting more nuanced calcium repletion.