Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients
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 ma...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2021-10-01
|
| Series: | Frontiers in Pediatrics |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2021.765306/full |
| _version_ | 1818691490416689152 |
|---|---|
| author | Morgan Burke Pranava Sinha Pranava Sinha Pranava Sinha Naomi L. C. Luban Naomi L. C. Luban Naomi L. C. Luban Nikki Gillum Posnack Nikki Gillum Posnack Nikki Gillum Posnack Nikki Gillum Posnack |
| author_facet | Morgan Burke Pranava Sinha Pranava Sinha Pranava Sinha Naomi L. C. Luban Naomi L. C. Luban Naomi L. C. Luban Nikki Gillum Posnack Nikki Gillum Posnack Nikki Gillum Posnack Nikki Gillum Posnack |
| author_sort | Morgan Burke |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-17T12:42:43Z |
| format | Article |
| id | doaj.art-95f905a8176f46cc9d7b45cce173b92d |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-17T12:42:43Z |
| publishDate | 2021-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-95f905a8176f46cc9d7b45cce173b92d2022-12-21T21:47:53ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602021-10-01910.3389/fped.2021.765306765306Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric PatientsMorgan Burke0Pranava Sinha1Pranava Sinha2Pranava Sinha3Naomi L. C. Luban4Naomi L. C. Luban5Naomi L. C. Luban6Nikki Gillum Posnack7Nikki Gillum Posnack8Nikki Gillum Posnack9Nikki Gillum Posnack10School of Medicine, George Washington University, Washington, DC, United StatesDepartment of Pediatrics, School of Medicine, George Washington University, Washington, DC, United StatesDivision of Cardiac Surgery, Children's National Hospital, Washington, DC, United StatesChildren's National Heart Institute, Children's National Hospital, Washington, DC, United StatesDepartment of Pediatrics, School of Medicine, George Washington University, Washington, DC, United StatesDepartment of Pathology, School of Medicine, George Washington University, Washington, DC, United StatesDivision of Hematology and Laboratory Medicine, Children's National Hospital, Washington, DC, United StatesDepartment of Pediatrics, School of Medicine, George Washington University, Washington, DC, United StatesChildren's National Heart Institute, Children's National Hospital, Washington, DC, United StatesDepartment of Pharmacology & Physiology, School of Medicine, George Washington University, Washington, DC, United StatesSheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, United StatesRed 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.https://www.frontiersin.org/articles/10.3389/fped.2021.765306/fulltransfusionhyperkalemiacardiac arrestpediatricneonatered blood cell storage lesion |
| spellingShingle | Morgan Burke Pranava Sinha Pranava Sinha Pranava Sinha Naomi L. C. Luban Naomi L. C. Luban Naomi L. C. Luban Nikki Gillum Posnack Nikki Gillum Posnack Nikki Gillum Posnack Nikki Gillum Posnack Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients Frontiers in Pediatrics transfusion hyperkalemia cardiac arrest pediatric neonate red blood cell storage lesion |
| title | Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients |
| title_full | Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients |
| title_fullStr | Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients |
| title_full_unstemmed | Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients |
| title_short | Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients |
| title_sort | transfusion associated hyperkalemic cardiac arrest in neonatal infant and pediatric patients |
| topic | transfusion hyperkalemia cardiac arrest pediatric neonate red blood cell storage lesion |
| url | https://www.frontiersin.org/articles/10.3389/fped.2021.765306/full |
| work_keys_str_mv | AT morganburke transfusionassociatedhyperkalemiccardiacarrestinneonatalinfantandpediatricpatients AT pranavasinha transfusionassociatedhyperkalemiccardiacarrestinneonatalinfantandpediatricpatients AT pranavasinha transfusionassociatedhyperkalemiccardiacarrestinneonatalinfantandpediatricpatients AT pranavasinha transfusionassociatedhyperkalemiccardiacarrestinneonatalinfantandpediatricpatients AT naomilcluban transfusionassociatedhyperkalemiccardiacarrestinneonatalinfantandpediatricpatients AT naomilcluban transfusionassociatedhyperkalemiccardiacarrestinneonatalinfantandpediatricpatients AT naomilcluban transfusionassociatedhyperkalemiccardiacarrestinneonatalinfantandpediatricpatients AT nikkigillumposnack transfusionassociatedhyperkalemiccardiacarrestinneonatalinfantandpediatricpatients AT nikkigillumposnack transfusionassociatedhyperkalemiccardiacarrestinneonatalinfantandpediatricpatients AT nikkigillumposnack transfusionassociatedhyperkalemiccardiacarrestinneonatalinfantandpediatricpatients AT nikkigillumposnack transfusionassociatedhyperkalemiccardiacarrestinneonatalinfantandpediatricpatients |