Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients

Frontiers in Pediatrics

Nikki Gillum Posnack¹  Naomi L. C. Luban²  Pranava Sinha³  Morgan Burke⁴ 

[1] Department of Pediatrics, School of Medicine, George Washington University, Washington, DC, United States;Children's National Heart Institute, Children's National Hospital, Washington, DC, United States;Department of Pharmacology & Physiology, School of Medicine, George Washington University, Washington, DC, United States;Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, United States;Department of Pediatrics, School of Medicine, George Washington University, Washington, DC, United States;Department of Pathology, School of Medicine, George Washington University, Washington, DC, United States;Division of Hematology and Laboratory Medicine, Children's National Hospital, Washington, DC, United States;Department of Pediatrics, School of Medicine, George Washington University, Washington, DC, United States;Division of Cardiac Surgery, Children's National Hospital, Washington, DC, United States;Children's National Heart Institute, Children's National Hospital, Washington, DC, United States;School of Medicine, George Washington University, Washington, DC, United States;

关键词: transfusion;    hyperkalemia;    cardiac arrest;    pediatric;    neonate;    red blood cell storage lesion;    red blood cell;   

DOI  :  10.3389/fped.2021.765306

来源: Frontiers

【 摘 要 】

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.

【 授权许可】

CC BY