Measuring potassium level in packed red blood cells before using: Word of caution for congenital cardiac surgery

Abstract

Background and Aim of the Study Transfusion‐associated hyperpotassemia is a serious complication of packed red blood cell (PRBC) transfusion after congenital cardiac surgery. Our study aimed to identify risk factors and potential preventive measures of transfusion‐associated hyperpotassemia in neonates and infants after congenital cardiac surgery. Methods Pediatric patients who underwent congenital cardiac surgery and need transfusion were enrolled in this prospective study. The potassium concentration of PRBC was checked from the sample taken from the segment. The volume of transfusion, age of PRBC, potassium concentration of unit were recorded. The estimated increment of potassium level in patients after PRBC transfusion was calculated. Results Seventy‐four individual patients, 95 distinct transfusions, 112 blood products were evaluated. The mean age of the blood unit was 3.8 ± 1.4 days. The mean potassium concentration in the PRBCs was 9.9 ± 2.4 mmol/L. A weak correlation was observed between the potassium value of the PRBC and the age of PRBC (p = 0.049, r = 0.2, y = 0.24 × x + −0.68). There was a weak correlation between the potassium value of PRBCs and the age of the unit (p < 0.001, r = 0.37, y = 2.8 × x + −3.6). Conclusions Before transfusion, even PRBC is fresh, measuring the potassium level of PRBC and the potassium that will be given to the pediatric patient with transfusion can prevent transfusion‐related hyperpotassemia and related complications. Otherwise, high potassium levels, which may be overlooked despite being fresh, may cause serious complications, even cardiac arrest, especially in neonates and infants.

Using umbilical cord blood as a source of paediatric packed red blood cells: Processing and quality control

“…Some authors have shown that potassium levels in paediatric transfusion, mainly to premature neonates, can induce hyperkalaemia and contribute to bad prognostic after the procedure. Altum et al [22] tested potassium levels in RBCs before using them to prevent hyperkalaemia in cardiac surgery cases, whereas other studies have evidenced that washing RBCs, mainly the irradiated ones, can also be a safe alternative to reduce potassium levels in them [23,24]. Thus, U-RBCs can be more beneficial, since their potassium levels were lower than those of A-RBCs.…”

Potassium Level Variation Following Packed Cell Transfusion in Critically Ill Adult Patients—How Alert Should We Be?

“…The other relevant parameter that may induce change in serum potassium is the “shelf age” of the transfused packed cells. Potassium concentration increases with the age of the packed cells [ 6 ].…”