World J Nephrol. Jan 6, ; 6 1 : Published online Jan 6, Author contributions : All authors contributed equally in data acquisition, analysis and interpretation of the data, drafting and critical revision of the manuscript.
Institutional review board statement : This case report was exempt from the Institutional Review Board standards at University Hospital of Ioannina. Informed consent statement : The patient involved in this study gave his written informed consent authorizing use and disclosure of his protected health information.
Conflict-of-interest statement : All the authors have no conflicts of interests to declare. Open-Access : This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. Complications of massive transfusion. Transfusion reactions: prevention, diagnosis, and treatment. Transfusion-associated hyperkalemia.
Transfus Med Rev. Hyperkalemia after packed red blood cell transfusion in trauma patients. J Trauma. Disorders of potassium. Emerg Med Clin North Am. Medford-Davis L , Rafique Z. Derangements of potassium.
Welling PA. Regulation of renal potassium secretion: molecular mechanisms. Semin Nephrol. Chronic hyperkalemia impairs ammonium transport and accumulation in the inner medulla of the rat.
J Clin Invest. Zubair AC. Clinical impact of blood storage lesions. Am J Hematol. A prospective study on red blood cell transfusion related hyperkalemia in critically ill patients. J Clin Med Res. A comparative study of reducing the extracellular potassium concentration in red blood cells by washing and by reduction of additive solution. Reduction in potassium concentration of stored red blood cell units using a resin filter.
Transfusion of irradiated red blood cell units with a potassium adsorption filter: A randomized controlled trial. Write to the Help Desk.
Clinical diagnosis An aggravation of baseline hyperkalemia was observed after massive blood transfusion in short time. Differential diagnosis Hyperkalemia associated with: Massive blood transfusion or acute renal failure. Pages May More article options.
Letter to the Editor. Hemolysis, hyperkalemia and the transfusion of packed old red blood cells in critically ill patients. Download PDF. Corresponding author. This item has received. Article information. Table 1. Table 2. Show more Show less. Full Text. A Project quality compromise agreed by the Spanish scientific societies 1. The empirical antibiotic treatment initiated after hospital admission due to serious infection should not be continued without prior daily assessment of its convenience, and possible therapeutic de-escalation.
Blood tests should not be conducted routinely, out of the specific clinical indications. No daily chest X-ray should be conducted at the ICU. Isolation measures should not be maintained, established in patients with confirmed communicable disease during their stay at the ICU. The measures should go on for as long as the infectious disease, or colonization lasts. There is one transfusion threshold of specific blood cell concentrates specific for different populations of critically ill patients.
Avoid frozen fresh plasma transfusions in critically ill patients without active hemorrhages, despite the alterations present in the clotting times. Consider one transfusion threshold of specific platelets for the different populations of critically ill patients.
Unit extracellular potassium increased in AS-5 units after day 7 at 0. The mean change in patient potassium concentration was 0. No correlation with unit age or unit potassium concentration was identified with change in patient whole-blood potassium concentration. A known effect of storing and irradiating packed red blood cells pRBCs is an increase in potassium concentration in the supernatant suspending the pRBCs. Children with disturbances in their potassium levels are susceptible to muscle weakness, paralysis, cardiac arrhythmia, and death.
The changes in serum potassium in children due to transfusion have been poorly characterized and may or may not be clinically significant. These changes have been studied in the past, 2 although in the past 30 years, many changes in transfusion medicine practice have occurred.
These include different anticoagulants, storage, and additive solutions. Since the s, there have been 11 case reports of transfusion-associated hyperkalemia in children; 4 of those 11 cases resulted in death. However the evidence supporting this use is weak, 4 although the reasoning behind it is judged to be sound by some authors. When blood is stored, potassium passively leaks from the cells, building in the medium surrounding the cells and leaving the red cells deficient in intracellular potassium.
When the stored unit of blood is transfused, this extracellular potassium is also infused. Much has been written about strategies 5—8 to deal with this potassium influx. However, in the setting of routine, nonemergent, or high-volume transfusion, the changes in serum potassium caused by giving nonwashed, irradiated RBCs are not well characterized. Published data exist for potassium concentrations in units preserved with citrate phosphate dextrose CPD 9 and citrate phosphate dextrose adenine 1 CPDA The study was powered to detect a significant change in serum potassium of 0.
With the laboratory methods being used, this results in the need for 17 transfusion events to be analyzed. Because of the relatively high number of pediatric hematology and oncology patients undergoing transfusion, this patient population was selected to be representative of the pediatric population receiving transfusions at academic medical centers and to shorten patient accrual time.
When a patient with central venous access was to undergo transfusion for any reason, the clinicians identified the child, and the child and parent or guardian provided consent. Only patients with central access were accrued in the study to maximize patient comfort, minimize hemolysis with blood draws, and ensure more uniform infusion rates.
A pretransfusion blood draw of 3 mL was performed through a central venous catheter and sent for analysis by the GEM Instrumentation Laboratories, Bedford, MA blood gas analyzer, which uses an ion-selective electrode to assess whole-blood potassium in the core clinical laboratory.
Whole-blood potassium was measured for ease of sampling, speed of specimen handling, speed of analysis, and to avoid the small and variable increase in potassium that occurs during centrifugation of whole blood to prepare plasma. Concurrently, a 3-mL sample was taken from the unit to be transfused.
In addition, the segments from the unit were sampled. The details of the unit, such as draw date, volume of transfusion, and date of transfusion, were recorded. All analytic instruments used in this study, which undergo daily in-house calibration, were always within calibration limits during the study. The transfusion was then given as clinically indicated.
No transfusion-related complications were noted during or after transfusions. All units were leukoreduced by filtration at the time of initial unit processing and irradiated within the 24 hours prior to sampling and transfusion.
No product was irradiated without a transfusion ordered and scheduled within the 24 hours after irradiation occurred. Patient information was obtained by medical record review. The most recent available result prior to transfusion was recorded for age, weight, sex, estimated glomerular filtration rate eGFR , serum creatinine, and primary diagnosis. A paired sample t test was used to determine whether unit potassium and segment potassium concentrations were equal.
AS-5—preserved units for the determination of potassium concentration changes over time were collected and processed at the Hershey Medical Center donor center, per normal protocol, on the day prior to unit selection. All units selected were collected without difficulty during phlebotomy in an Immuflex Terumo BCT bag Terumo, Tokyo, Japan , leukoreduced by filtration, and processed for plasma and platelet collection as well as pRBCs.
Units were then stored on their own shelf in the blood bank refrigerator and disturbed only for sampling. Potassium concentration was measured on the day of selection day 0 and every 7 days afterward, until day Blood samples were collected for testing with the use of a neonatal aliquot system Charter Medical, Winston-Salem, NC to avoid puncturing the unit, and care was taken to avoid hemolysis when samples were obtained.
A 3-mL sample was obtained from the aliquot bag into a heparin-Vacutainer tube. This was hand carried to the Hershey Medical Center clinical chemistry laboratory, spun for 7 minutes at rpm, and measured on the VITROS 5,1 Ortho Diagnostics chemistry platform via ion-selective slide technology.
A total of 9 individual patients received 17 distinct transfusions. The children ranged in age from 1 to 14 years and weighed between 8. Hyperkalemia-induced by rapid red cell transfusion is a well-known severe complication of transfusion; however, in patients with sudden massive hemorrhage, rapid red cell transfusion is necessary to save their life. In such cases, it is extremely important to monitor serum potassium levels. For an emergency situation, a system should be developed to ensure sufficient preparation for immediate transfusion and laboratory tests.
Furthermore, sufficient stock of preparations to treat hyperkalemia, such as calcium preparations, diuretics, glucose, and insulin is required.
Moreover, a transfusion filter that absorbs potassium has been developed and is now available for clinical use in Japan. The filter is easy to use and beneficial, and should be prepared when it is available. Keywords: Hyperkalemia; massive hemorrhage; potassium absorption filter; rapid red cell transfusion.
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