ArticleFrontiers in oncology2026
A two-phase low-dose ACD-A strategy overcomes hypocalcemia during peripheral blood stem cell collection: a randomized controlled study.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Citrate anticoagulation during peripheral blood stem cell (PBSC) collection frequently causes hypocalcemia. Conventional fixed-ratio protocols frequently employ prophylactic calcium supplementation in many centers; however, they are associated with a high citrate burden and have been linked to platelet aggregation in some reports. This randomized controlled study evaluated a two-phase low-dose Acid Citrate Dextrose formula A (ACD-A) strategy designed to reduce hypocalcemia without compromising collection efficiency. Methods: Consecutive donors undergoing PBSC collection were randomly assigned to two groups. The Control group (n=22) received a blood-to-ACD-A ratio of 10-12:1 with prophylactic intravenous calcium. The Low ACD-A group (n=21) received initial loading phase at a ratio of 10-12:1 until 1 mL/kg of ACD-A was infused, followed by maintenance at 25:1 without prophylactic calcium. The primary outcome was the incidence of hypocalcemia-related symptoms. Secondary outcomes included collection time, ACD-A intake, CD34+ cell yield, and platelet aggregation. Results: The incidence of hypocalcemia-related symptoms was significantly lower in the Low ACD-A group than in the Control group (14% vs. 73%, Conclusions: A two-phase low-dose ACD-A strategy significantly reduces hypocalcemia-related symptoms, shortens collection time, and decreases platelet aggregation without compromising stem cell yield or product quality. This simple modification represents a meaningful improvement over conventional citrate protocols for PBSC collection.
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