Application of the continuous autotransfusion system (CATS) to prevent transfusion-related hyperkalemia following hyperkalemic cardiac arrest in an infant -A case report-

Abstract

Transfusion-induced hyperkalemia can lead to cardiac arrest, especially when the patient rapidly receives a large amount of red blood cells (RBCs), previously stored for a long period of time, irradiated or both. We report on a case of application of the Continuous AutoTransfusion System (CATS) to wash RBCs, in order to lower the high potassium (K+) level in the packed RBCs unit, during massive transfusion following transfusion-induced hyperkalemic cardiac arrest. After the washing process using CATS, there was no more electrocardiographic abnormality or cardiac arrest due to hyperkalemia. This case emphasizes the potential risk to develop transfusion-related hyperkalemic cardiac arrest, during massive transfusion of irradiated, pre-stored RBCs. CATS can be effectively used to lower the K+ concentration in the packed RBCs unit, especially when the risk of transfusion-induced hyperkalemia is high.

Comparison of bicarbonate‐buffered fluid and isotonic saline solution as Cell Saver washing fluids for packed red blood cells

“…Both washing solutions effectively reduced the critical concentration of potassium to acceptable values (Table ), thus decreasing the likelihood of a clinically relevant hyperkalemia, even in the event of hyperinfusion/MT . This potassium‐lowering effect is one of the main reasons to wash PRBCs and should reduce the risk of cardiac arrest events in infants .…”

“…Packed red blood cells preserved in extended storage media are routinely dispensed by most blood banks. Due to this preservation solutions, PRBCs frequently contain high concentrations of phosphate, potassium and glucose in an unphysiological acid–base environment and require washing procedures before MT to neonates and infants to avoid transfusion‐associated hyperkalemia, hyperglycemia and acid–base balance disturbances .…”

“…Although normal saline solution is a commonly used washing fluid for Cell Savers , the composition of normal saline solution is far from physiological. The potential acidifying effect of NaCl on plasma has been shown in several trials .…”

“…In major pediatric and cardiac surgery, transfusion of packed red blood cells (PRBCs) is used to prevent anemia and hemorrhagic shock. Although the use of PRBCs can be essential for maintaining adequate oxygen delivery in small infants, massive transfusion (MT, transfusion of >100% of total blood volume in 24 h) may cause significant disturbances of acid–base balance and electrolyte and glucose concentrations, which have been associated with serious complications including cardiac arrest and death . These complications are primarily due to the composition of the PRBC preservation solution (high potassium and glucose concentrations and low pH values), which are necessary for the adequate preparation and storage of the cells .…”

Double-filtered leukoreduction as a method for risk reduction of transfusion-associated graft-versus-host disease

“…However, the procurement and maintenance of irradiators in hospital blood banks is a challenging task, and the cost of irradiators are increasing. Therefore, relying on blood centers or other transfusion services to perform the irradiation is a common practice, and this, in turn, can result in delays in the administration of blood products to patients and adverse effects related to the irradiation of blood components, such as hyperkalemia, is another undesirable side effect [8][9][10][11]. A study conducted in Japan reported that patients demonstrating electrocardiogram changes caused by hyperkalemia following the infusion of irradiated units have increased since irradiated blood was introduced nationwide [12].…”