Hyperkalemia Following Massive Transfusion in Trauma

Red blood cell transfusion, hyperkalemia, and heart failure in advanced chronic kidney disease

“…Indeed, the clinical consequences of hyperkalemia can range from mild elevations with no electrocardiographic changes to more pronounced elevations that can lead to ventricular fibrillation or asystole, cardiac arrest, or death. 20,37,38 Most descriptions of hyperkalemia after an RBC transfusion are at the level of case reports 39,40 or small non-experimental studies of trauma 17,18,41 and cardiology patients. 19,[42][43][44] Ours is the first study to investigate the association between RBC transfusion and hyperkalemia in a large population of patients with advanced CKD, using a design well-suited for assessing safety.…”

“…[9][10][11][12][13] Transfusion is also known to cause allosensitization that can significantly reduce the likelihood of kidney transplantation and, among patients fortunate enough to receive a transplanted kidney, can accelerate allograft failure. [14][15][16] While RBC transfusion is thought to contribute to the development of hyperkalemia and heart failure because of the CKD patients' reduced ability to precisely and quickly respond to an expanded potassium load or extracellular volume, [17][18][19][20] these risks have not been previously quantified.…”

Trauma‐related electrolyte disturbances: From resuscitation to rhabdomyolysis

“…44 In contrast with traumatic hypokalemia, hyperkalemia has significant effects on cardiac function, potentially leading to arrhythmias or death, which is more likely in a younger population less tolerant of a sudden rise in potassium. 44,45 A large release of potassium after massive cell injury could explain some episodes of traumatic cardiac arrest, particularly when the pattern of injury is not consistent with sudden death. 46 Although patients rarely present with hyperkalemia, the development of an elevated potassium is not unusual, particularly if a patient requires blood.…”

“…9 Studies from the military experience in Iraq and Afghanistan identified rates of hyperkalemia between 29% and 38.5%, 44,47 whereas a study out of Vanderbilt showed that 4.6% of patients receiving a massive transfusion developed a potassium >5.5 mEq/L. 45 In all of these studies, the biggest risk factor for hyperkalemia was receiving a transfusion. Stored red blood cells (RBCs) contain ~5-30 mEq/L of potassium, 48 and fresh frozen plasma contains a surprising amount of potassium as well.…”

Massive Transfusion

“…Humans receiving large volumes of stored blood products may therefore be at greater risk for the development of hyperkalemia. 17 It is likely that the hyperkalemia observed in canine cases resulted from similar causes, including potassium leakage into the bloodstream from damaged tissues, extracellular potassium shift secondary to acidosis, and reduced potassium excretion associated with oliguria. 15,16 Although this would suggest that hyperkalemia in massively transfused canine patients should theoretically be less of a concern, hyperkalemia was identified in 20% of dogs in one study, a prevalence similar to that historically reported in human patients.…”