Is depletion of potassium in blood before transfusion essential?

Silva, Mahes de; Seghatchian, M.J.

doi:10.1016/s0140-6736(94)91325-0

Cited by 6 publications

(5 citation statements)

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“…The high potassium level is a result of leakage of potassium ions from red blood cells into the plasma and the increase is proportional to the duration of storage of the blood (Table 2). Potassium concentrations as high as 70 mmol.l À1 in Day 28 irradiated blood have been measured [5]. However, in this patient, 17-day-old SAG-M would be expected to have extracellular potassium levels of around 30 mmol.l À1 ; this was a large potassium load if we consider that she had received more than a quarter of her circulating blood volume over a few minutes.…”

Section: Discussionmentioning

confidence: 86%

‘Near‐miss’ hyperkalaemic cardiac arrest associated with rapid blood transfusion

Carvalho

Quiney

1999

Anaesthesia

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SummaryA case is presented in which a relatively modest blood transfusion resulted in acute hyperkalaemia with a 'near-miss' cardiac arrest. While transfusion-related hyperkalaemia usually occurs in association with massive transfusions, several factors may have increased the risk of such an acute reaction. A high index of suspicion is required, especially in patients with risk factors. Anaesthetists should not be lulled into a false sense of security simply because modest volumes of blood are being transfused. Hyperkalaemia is an established complication of blood transfusions. Most cases of significant hyperkalaemia and cardiac arrest have involved neonates [1] or adults receiving massive transfusion [2]. We describe a patient in whom a relatively modest blood transfusion resulted in acute hyperkalaemia with a 'near-miss' cardiac arrest. Case historyA frail 74-year-old woman was scheduled for an exploratory laparotomy for a suspected uterine malignancy. She had a history of longstanding hypertension and hypothyroidism, but no history of ischaemic heart disease. She was a nonsmoker and had, until recently, a good exercise tolerance for her age. Medication on admission included amlodipine 5 mg daily and thyroxine 100 mg daily.On examination she was markedly cachectic, weighing only 42 kg, and had a hard mass protruding from her pelvis into her lower abdomen.Her pre-operative ECG was normal and laboratory investigations showed a haemoglobin of 12.7 g.dl À1 , a normal coagulation profile, potassium of 4.4 mmol.l À1 , albumin of 35 g.dl À1 and normal urea and creatinine levels.After application of routine monitoring, anaesthesia was induced with propofol (1.5 mg.kg À1 ) and fentanyl citrate (3 mg.kg À1 ). Cisatracurium besylate (0.20 mg.kg À1 ) was used to facilitate tracheal intubation and the patient's lungs were ventilated with a 50 : 50% mixture of oxygen, nitrous oxide and 1% isoflurane. A 14G peripheral intravenous, 20G radial arterial cannula and a triple-lumen internal jugular central venous pressure (CVP) line were positioned after the induction of anaesthesia.Laparotomy revealed a large, locally aggressive leiomyosarcoma arising from the uterus, and a radical hysterectomy and a debulking procedure was planned.Approximately 1 h after the start of surgery, during debulking of the tumour mass, a sudden blood loss of approximately 1500 ml caused a sudden decrease in the patient's blood pressure from 130/85 mmHg to 75/ 40 mmHg. This was associated with a tachycardia and rapid decrease in the CVP from 6 mmHg to 0 mmHg.Initial fluid resuscitation with 1000 ml 0.9% saline and 1000 ml Haemaccel® solution produced a temporary improvement in the patient's blood pressure. After further blood loss, a blood transfusion was started with two units (740 ml) of blood, which was transfused rapidly over 5-10 min via a fluid warming system. During the rapid infusion of blood, the ECG was noted to show an increase in the size of the T waves, followed rapidly by a widening of the QRS complexes. The pulse rate decreased from 80

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Section: Discussionmentioning

confidence: 86%

‘Near‐miss’ hyperkalaemic cardiac arrest associated with rapid blood transfusion

Carvalho

Quiney

1999

Anaesthesia

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“…It is now well documented that the potassium concentration of 7‐day‐old blood units (packed RBCs stored in AS‐1) is around 23 mmol L −1 , whereas that of the 42‐day‐old blood units, in AS‐1, is in the 50 mmol L −1 range (Vengelen‐Tyler, 1999). Potassium concentrations as high as 70 mmol L −1 have been reported in 28‐day‐old, irradiated blood units stored in SAG‐M (De Silva & Seghatchian, 1994; Carvalho & Quiney, 1999). Campbell (1955) has reported that 7‐day‐old blood units used in exchange transfusions of infants with haemolytic disease have potassium levels in the range of 6·5–8 mmol L −1 .…”

Section: Discussionmentioning

confidence: 99%

An unusual case of hyperkalaemia‐induced cardiac arrest in a paediatric patient during transfusion of a ‘fresh’ 6‐day‐old blood unit

Baz¹,

Kanazi

Mahfouz

et al. 2002

Transfusion Medicine

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A well-recognized complication of the transfusion of red blood cells (RBCs) is hyperkalaemia. This occurs in paediatric or adult patients receiving massive transfusion and can lead to cardiac arrest. Hyperkalaemia may follow the transfusion of 'stored' RBCs and/or haemolysed units, and depends on the quantity and rate of transfusion. We report on an unusual case of hyperkalaemia-induced cardiac arrest during transfusion of a 'fresh' blood unit. A 62-day-old baby girl was scheduled for a construction of a Blalock-Taussig shunt, after the completion of anastomosis, and upon release of vascular control, there was bleeding at the anastomotic site that was controlled with a suture placement. To compensate for the blood loss, a stat order was given for a push of 120 mL of RBCs over 10 min through the inferior vena cava central line. The blood unit was 6 days old and had been gamma-irradiated 48 h earlier. Shortly after the transfusion, the patient's electrocardiogram showed changes typical of hyperkalaemia; she then went into cardiac asystole. The blood unit potassium concentration was 55.3 mmol L-1, which flushed the atrioventricular node during transfusion. This is the first report of a high potassium level found in a 'fresh', less than 7 days old, nonhaemolysed RBC blood unit. The high concentration of potassium in this unit seems to be due to accelerated alterations of the RBC sodium/potassium adenosine triphosphatase pump (Na+/K+ pump), resulting in the release of intracellular potassium. This early and severe alteration of the pump and the unusually high potassium level may be due to as yet unexplained causes, warranting awareness, future investigation and routine saline washing of 'fresh' RBCs for paediatric patients who are candidates for central line transfusion.

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“…Even though the theoretical risks exist, K + overload by RBC transfusion is not considered a serious problem, because few severe incidents have been reported. Slow transfusion, using fresh blood and washed RBCs to prevent the sudden onset of hyperkalemia, is common 9 . Rapid transfusion is dangerous in patients with massive bleeding, 10–13 pediatric or neonatal patients, 14–17 and patients with renal failure, 18,19 all of whom are at high risk of cardiac arrest due to hyperkalemia.…”

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confidence: 99%