Repeated cardiac arrests caused by transfusion-related hyperkalemia and massive bleeding : A case report

Choi, Seung Pyo; Kim, Hyun Jung; Kim, Hee Soo; Kim, Chong Sung; Kim, Seong Deok; Kim, Jin Tae

Case Report

Pediatric Anesthesia

Anesthesia and Pain Medicine 2009;4(2):179-182.
Published online April 30, 2009.

Repeated cardiac arrests caused by transfusion-related hyperkalemia and massive bleeding : A case report

Seung Pyo Choi, Hyun Jung Kim, Hee Soo Kim, Chong Sung Kim, Seong Deok Kim, Jin Tae Kim

Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea. kimjintae73@dreamwiz.com

Abstract

Transfusion-related hyperkalemic cardiac arrest (TRHCA) is a serious complication of administration of packed red blood cell (P-RBC). We present a case of repeated TRHCAs in a 13 month-old girl, who was undergoing intra-abdominal huge mass excision. There were three consecutive TRHCAs during the operation. The first (11.7 mM of K+) and the second (9.5 mM of K+) cardiac arrests were successfully resuscitated. However, the last cardiac arrest (8.9 mM of K+) was failed to be recovered with conventional treatment. Risk factors of TRHCA such as hypocalcemia, hypoxemia, acidosis, hyperglycemia, hyperlactatemia, and low cardiac out state were combined. The transfused P-RBCs were all irradiated. In this situation, processing of P-RBC using an autotransfusion device before the transfusion should be considered to prevent hyperkalemia in addition to conventional treatment of TRHCA.

Key Words: cardiac arrest, hyperkalemia, transfusion