Fatal Hyperkalemia Due to Rapid Red Cell Transfusion in a Critically Ill Patient

Tsukamoto, S.; Maruyama, Koichi; Nakagawa, Hideyuki; Iwase, Yoshinori; Kitamura, Akira; Hayashida, Masakazu

doi:10.1272/jnms.76.258

Cited by 10 publications

(11 citation statements)

References 8 publications

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“…Rapid transfusion is also often linked to TAH occurrence 2, 16, 17 . In addition to the fact that hyperkalemia causes suppression of electrical activity, Brown et al 2 reported that rapid RBC transfusion might depress cardiac output due to ineffective cardiac contraction, resulting in an acute increase in the K+ concentration in hypovolemic children (10–15 kg).…”

Section: Discussionmentioning

confidence: 99%

Transfusion‐associated hyperkalemia in pediatric population: Prevalence, risk factors, survival, infusion rate, and RBC unit features

et al. 2021

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Background Hyperkalemia is a rare life‐threatening complication of red blood cell (RBC) transfusion. Stored RBCs leak intracellular potassium (K+) into the supernatant; irradiation potentiates the K+ leak. As the characteristics of patients and implicated RBCs have not been studied systematically, a multicenter study of transfusion‐associated hyperkalemia (TAH) in the pediatric population was conducted through the AABB Pediatric Transfusion Medicine Subsection. Study Design The medical records of patients <18 years old were retrospectively queried for hyperkalemia occurrence during or ≤12 h after the completion of RBC transfusion in a 1‐year period. Collected data included patient demographics, diagnosis, medical history, timing of hyperkalemia and transfusion, mortality, and RBC unit characteristics. Results/Findings A total of 3777 patients received 19,649 RBC units during the study period in four facilities. TAH was found in 35 patients (0.93%) in 37 occurrences. The patient median age and weight were 1.28 years and 9.80 kg, respectively. All patients had multiple serious comorbidities. There were 79 RBC units transfused in the TAH events; 62% were irradiated, and the median age of the units was 10 days. The median total RBC volume transfused ≤12 h before TAH was 24% of patient estimated total blood volume, and the median infusion rate (IR) was19.6 ml/kg/h. Mortality rate within 1 day after the TAH event was 20%. Conclusions The prevalence of TAH in children was low; however, the 1‐day mortality rate was 20%. Patients with multiple comorbidities may be at higher risk for TAH. The IR was higher for patients who had TAH than the IR threshold for safe transfusion.

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Section: Discussionmentioning

confidence: 99%

Transfusion‐associated hyperkalemia in pediatric population: Prevalence, risk factors, survival, infusion rate, and RBC unit features

et al. 2021

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“…In a study by Swindell and colleagues, 3 all 11 neonates receiving irradiated RBCs during cardiopulmonary bypass developed hyperkalemia, four of them with values exceeding 6 mmol/L and two with ventricular fibrillation. Hyperkalemia and the cardiodepression involved is aggravated by prior blood irradiation, longer storage time, rapid infusion, concomitant hypocalcemia, acidosis, and hypothermia and deteriorates preexisting electrolyte disturbances after reperfusion or renal failure 7,9,11 …”

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confidence: 99%

Washing of banked blood by three different blood salvage devices

et al. 2012

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Autotransfusion devices offer a practical and obviously economical option to wash banked RBCs intraoperatively to prevent hyperkalemia and other disturbances in massive transfusion or pediatric patients. Predilution improves elimination rates, especially in devices that produce high product Hct levels. With a Y-tubing the RBCs should bypass reservoir and vacuum, and the procedure should be guarded by a policy and procedure manual and a quality management system.

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“…Smith, Farrow, Ackerman, Stubbs, and Sprung (2008) examined blood component transfusion-associated hyperkalemic intraoperative cardiac arrest among 16 patients and found that K þ levels averaged 7.2 + 1.4 mEq/L following rates of PRBC transfusion that ranged from 1 unit in a neonate to 54 units in an adult patient. Recent investigations have supported findings such as these, though these have been primarily case studies and reports of individual instances (Martin et al, 2013;Tsukamoto et al, 2009). Nonetheless, these investigations demonstrate the need for evaluation of electrolyte levels in PRBCs that are to be transfused and the potential adverse impact on patient outcomes.…”

Section: Stored Prbc Factorsmentioning

confidence: 91%

From Donor to Recipient: Considerations for Blood Transfusion Outcomes Research

Jones

Brown

Vance

2017

Biological Research For Nursing

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Donated blood can be broken down into blood components for use in patient care. This article focuses primarily on packed red blood cells (PRBCs), as they experience breakdown during storage that may adversely impact patient outcomes. Patients require PRBC transfusions for a number of clinical reasons. Although transfusions of PRBCs provide some clinical benefit, they are also associated with increased morbidity and mortality across multiple patient populations, albeit the mechanisms underlying this relationship remain unclear. With an aging, more acutely ill population requiring aggressive treatment and a lack of transfusion alternatives, research focused on PRBCs has gained momentum. Proper interpretation of research findings on the part of clinicians depends on accurate data collection that includes aspects of both the transfused blood components and the recipients. The purpose of this article is to examine stored PRBC factors, blood-donor characteristics, transfusion-specific factors, and patient-specific characteristics as they relate to patient outcomes research. Challenges associated with performing and interpreting outcomes of transfusion-related research are presented. Implications of current evidence for patient care, such as awareness of benefits as well as risks associated with blood component transfusion, are also provided.

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Fatal Hyperkalemia Due to Rapid Red Cell Transfusion in a Critically Ill Patient

Cited by 10 publications

References 8 publications

Transfusion‐associated hyperkalemia in pediatric population: Prevalence, risk factors, survival, infusion rate, and RBC unit features

Transfusion‐associated hyperkalemia in pediatric population: Prevalence, risk factors, survival, infusion rate, and RBC unit features

Washing of banked blood by three different blood salvage devices

From Donor to Recipient: Considerations for Blood Transfusion Outcomes Research

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