CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Clinical pathology abstracts editor: Deborah Sesok-Pizzini, MD, MBA, associate professor, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and medical director, Blood Bank and Transfusion Medicine, Children’s Hospital of Philadelphia.
Transfusion-associated hyperkalemic cardiac arrest in pediatric patients
Hyperkalemic cardiac arrest is a potential complication in pediatric patients undergoing rapid massive transfusion. Identifying patients at particular risk for this reaction is critical for determining the best strategies to prevent transfusion-associated hyperkalemic cardiac arrest (TAHCA). Concerns arise over the use of older blood in at-risk pediatric patients. The authors examined the case reports and studies related to transfusion-associated cardiac arrest in a pediatric population. They reviewed nine case reports and six clinical studies involving massive transfusion. The authors noted that, in some cases, patients received smaller volume transfusions that resulted in TAHCA. The common factors that were associated with TAHCA in patients who received rapid transfusions were acidosis, hyperglycemia, hypocalcemia, and hypothermia at the time of arrest. The investigators also identified measures to reduce TAHCA in young children, such as anticipating and replacing blood loss before significant hemodynamic compromise occurs, using a larger bore (greater than 23-gauge) peripheral intravenous catheter in lieu of central venous lines, avoiding the use of rapid infusers, frequently checking and treating electrolyte abnormalities, using fresh red blood cells for massive transfusions in infants, reducing the plasma volume of RBC units, minimizing intervals between irradiation and transfusion, and considering washing RBCs or reducing plasma as indicated. The authors concluded that this review helped provide insight into the risk and prevention of TAHCA in pediatric patients. However, the reporting of these reactions still needs to be standardized to better identify at-risk pediatric populations.
Lee AC, Reduque LL, Luban NCL, et al. Transfusion-associated hyperkalemic cardiac arrest in pediatric patients receiving massive transfusion. Transfusion. 2014;54:244–254.
Correspondence: Angela C. Lee at alee@cnmc.org