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Probable Hypocalcemia Induced Ventricular Fibrillation and Torsades de Pointes following Blood Product Administration

Christian M Mosebach1, Jeffrey Kluger2

  • 1Internal Medicine, University of Connecticut, Farmington, USA.

Cureus
|March 2, 2019
PubMed

Insights

Citrate in blood products can cause hypocalcemia, leading to dangerous heart rhythm problems like prolonged QTc interval, ventricular fibrillation, and Torsades de Pointes. This rare complication requires careful monitoring during transfusions.

Area of Science:

  • Cardiology
  • Transfusion Medicine
  • Critical Care Medicine

Background:

  • Open-heart surgery often necessitates multiple blood product transfusions.
  • Blood products contain citrate as an anticoagulant and preservative.
  • Citrate can chelate serum calcium, potentially leading to hypocalcemia.

Observation:

  • A 35-year-old male developed hypocalcemia following extensive blood transfusions.
  • The patient experienced a prolonged corrected QT (QTc) interval.
  • The patient had separate episodes of ventricular fibrillation and Torsades de Pointes (TdP).

Findings:

  • Transfusion-associated citrate toxicity (TACT) can precipitate severe cardiac arrhythmias.
  • Hypocalcemia induced by citrate chelation is a direct cause of QTc prolongation.
  • Ventricular arrhythmias, including TdP, are significant risks associated with transfusion-induced hypocalcemia.

Implications:

  • Clinicians must be vigilant for TACT in patients receiving massive transfusions.
  • Monitoring ionized calcium levels is crucial in patients undergoing massive transfusion protocols.
  • Prompt recognition and management of hypocalcemia can prevent life-threatening arrhythmias after blood transfusions.

Keywords:
arrhythmiablood transfusioncitratehypocalcemiatorsades de pointesventricular arrhythmias

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