Red blood cell (RBC) transfusions are a life-saving intervention, with nearly 14 million RBC units transfused in the United States each year. However, the safety and efficacy of this procedure can be influenced by variations in the collection, processing, and administration of RBCs. Procedures or manipulations that increase potassium (K) levels in stored blood products can also predispose patients to hyperkalemia and transfusion-associated hyperkalemic cardiac arrest (TAHCA). In this mini review, we aimed to provide a brief overview of blood storage, the red cell storage lesion, and variables that increase extracellular [K]. We also summarize cases of TAHCA and identify potential mitigation strategies. Hyperkalemia and cardiac arrhythmias can occur in pediatric patients when RBCs are transfused quickly, delivered directly to the heart without time for electrolyte equilibration, or accumulate extracellular K due to storage time or irradiation. Advances in blood banking have improved the availability and quality of RBCs, yet, some patient populations are sensitive to transfusion-associated hyperkalemia. Future research studies should further investigate potential mitigation strategies to reduce the risk of TAHCA, which may include using fresh RBCs, reducing storage time after irradiation, transfusing at slower rates, implementing manipulations that wash or remove excess extracellular K, and implementing restrictive transfusion strategies.
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| http://dx.doi.org/10.3389/fped.2021.765306 | DOI Listing |
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Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients.
Front Pediatr
October 2021
Department of Pediatrics, School of Medicine, George Washington University, Washington, DC, United States.
Red blood cell (RBC) transfusions are a life-saving intervention, with nearly 14 million RBC units transfused in the United States each year. However, the safety and efficacy of this procedure can be influenced by variations in the collection, processing, and administration of RBCs. Procedures or manipulations that increase potassium (K) levels in stored blood products can also predispose patients to hyperkalemia and transfusion-associated hyperkalemic cardiac arrest (TAHCA).
View Article and Find Full Text PDFA prospective study on red blood cell transfusion related hyperkalemia in critically ill patients.
J Clin Med Res
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Department of Internal Medicine, Brookdale University Hospital & Medical Center, 1 Brookdale Plaza, Brooklyn, New York, NY 11212, USA.
Background: Transfusion-associated hyperkalemic cardiac arrest is a serious complication in patients receiving packed red blood cell (PRBC) transfusions. Mortality from hyperkalemia increases with large volumes of PRBC transfusion, increased rate of transfusion, and the use of stored PRBCs. Theoretically, hyperkalemia may be complicated by low cardiac output, acidosis, hyperglycemia, hypocalcemia, and hypothermia.
View Article and Find Full Text PDFTransfusion-associated hyperkalemic cardiac arrest in pediatric patients receiving massive transfusion.
Transfusion
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Division of Anesthesiology and Pain Medicine, Division of Laboratory Medicine, Children's National Medical Center; Department of Anesthesiology and Pediatrics, Department of Pediatrics and Pathology, George Washington University School of Medicine and Health Sciences, Washington, DC; Transfusion Medicine Division, Department of Pathology, Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine; Clinical Liaison for Library Services, Welch Medical Library, Johns Hopkins University, Baltimore, Maryland.
Background: Hyperkalemic cardiac arrest is a potential complication of massive transfusion in children. Our objective was to identify risk factors and potential preventive measures by reviewing the literature on transfusion-associated hyperkalemic cardiac arrest (TAHCA) in the pediatric population.
Study Design And Methods: Literature searches were performed in MEDLINE and the Cochrane Database of Systematic Reviews.
Transfusion-associated hyperkalemia.
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July 2011
Transfusion Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, Ontario, Canada.
The supernatant potassium concentration [K+] of red blood cell (RBC) units is frequently much higher than normal human plasma potassium levels, especially in units nearing the end of their storage life. Clinical hyperkalemia resulting from RBC transfusions has been recognized as a transfusion complication for decades, and there have been reported cardiac arrests attributed to transfusion-associated hyperkalemia. This review summarizes the evidence surrounding RBC [K+] levels, effects of irradiation and washing on [K+], the evidence for clinical hyperkalemia and cardiac arrests resulting from transfusion, predictors of post-transfusion hyperkalemia, and their preventative strategies.
View Article and Find Full Text PDFCardiac arrests associated with hyperkalemia during red blood cell transfusion: a case series.
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Department of Anesthesiology, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Background: Transfusion-associated hyperkalemic cardiac arrest is a serious complication of rapid red blood cell (RBC) administration. We examined the clinical scenarios and outcomes of patients who developed hyperkalemia and cardiac arrest during rapid RBC transfusion.
Methods: We retrospectively reviewed the Mayo Clinic Anesthesia Database between November 1, 1988, and December 31, 2006, for all patients who developed intraoperative transfusion-associated hyperkalemic cardiac arrest.
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