During an exchange transfusion for sickle cell crisis, the patient becomes anxious and reports tingling...

Citrate, a preservative used in banked blood, binds withcalcium, causinghypocalcemia—a known complication ofrapid or large-volume transfusionslike exchange transfusion. Symptoms includeperioral tingling, numbness, muscle twitching, and anxiety. Administration ofIV calcium gluconate or calcium chlorideis indicated.

“Rapid transfusion of blood products can result in hypocalcemia due to citrate toxicity. Signs include tingling, muscle irritability, and anxiety. Calcium replacement is required.”

(Referenced from CCRN Pediatric – Direct Care: Hematology, Transfusion Reactions and Electrolyte Management)