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Prospective study of potassium-associated acute transfusion events in pediatric intensive care
Christopher S Parshuram1, Ari R Joffe
1Department of Pediatrics, University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada.
Insights
This study found that packed red blood cell transfusions did not significantly alter potassium levels or cause adverse events in critically ill children. These findings suggest transfusions are safe for pediatric patients, even when rapid.
Area of Science:
- Pediatric critical care medicine
- Transfusion medicine
- Clinical biochemistry
Background:
- High potassium in packed red blood cells (PRBCs) linked to fetal/neonatal cardiac issues.
- Need to assess PRBC transfusion effects in critically ill children.
Purpose of the Study:
- Determine biochemical and clinical effects of PRBC transfusions in critically ill children.
- Evaluate PRBC potassium levels and associated adverse events.
Main Methods:
- Prospective case series of 28 critically ill children (1 week-12 years).
- Measured potassium in PRBCs and patient serum before/after transfusion.
- Monitored for hyperkalemia, arrhythmia, cardiac arrest, and death for 4 hours post-transfusion.
Main Results:
- 54 PRBC transfusions administered (mean 11.8 mL/kg).
- No significant change in mean patient potassium levels pre- and post-transfusion.
- No hyperkalemia, arrhythmia, cardiac arrest, or deaths observed.
- Rapid bolus transfusions did not elevate potassium above 5 mmol/L.
Conclusions:
- PRBC transfusions are safe in critically ill children, with no significant potassium changes or acute adverse events.
- Further research needed on rapid and central venous transfusions in this population.
Objective:
Transfusion of packed red blood cells containing high concentrations of potassium have been associated with fetal and neonatal arrhythmia and hyperkalemic cardiac arrest. This study sought to determine the biochemical and associated clinical effects of packed red blood cells transfusion in critically ill children.
Design:
Prospective case series.
Setting:
Tertiary multidisciplinary university hospital pediatric intensive care unit.
Patients:
Consecutive sample of 28 children 2.7-27 kg (1 wk to 12 yrs old) receiving a packed red blood cell transfusion.
Interventions:
None.
Measurements And Main Results:
Potassium concentration was prospectively measured from packed red blood cell transfusions. Adverse events were recorded during and for 4 hrs following transfusion including hyperkalemia, therapy for hyperkalemia, arrhythmia, cardiac arrest, and death. There were 54 packed red blood cell transfusions (mean volume of 11.8 +/- 2.8 mL/kg). The measured packed red blood cell potassium concentration was > 25 mmol/L in 16, 15-25 mmol/L in 11, and < 15 mmol/L in 25. The mean patient potassium concentrations before (3.85 +/- 0.55, range 2.7-5.2 mmol/L) and after transfusion (3.94 +/- 0.62, range 2.8-5.7 mmol/L) were not significantly different. There was no therapy required for hyperkalemia, no new arrhythmia, no cardiopulmonary arrest, and no deaths during and up to 4 hrs following transfusion. Of the six children given a bolus of packed red blood cells (> or = 5 mL/kg over < 10 mins), the maximum increase in patient potassium concentration was 0.8 mmol/L, in a child who had an initial potassium concentration of 2.7 mmol/L. No patient's potassium concentration was > 5 mmol/L following rapid transfusion.
Conclusions:
This prospective study found no significant change in patient potassium concentration and no acute adverse events related to transfusion in critically ill children, including those receiving packed red blood cells by bolus. Larger prospective studies are required to evaluate the acute effects of rapid and central venous transfusion in critically ill children.