Transfusion-associated hyperkalemia in pediatric population: Analyses for risk factors and recommendations

Transfusion-associated hyperkalemia (TAH) is a potentially life-threatening complication of red blood cell (RBC) transfusion. Previously, we reported features of RBC transfusions from 35 pediatric patients (TAH group) who had hyperkalemia with RBC transfusion in one-year period at four facilities. In this study, we used multivariate analyses and artificial intelligence to compare the TAH group to newly collected control group (non-TAH group) to identify factors associated with TAH occurrence.

A review of RBC transfusion with TAH was compared to non-TAH group who did not develop TAH with RBC transfusion at each facility during the same one-year period. The non-TAH group included 12 patients each in 5 age groups. Wilcoxon rank-sum tests recursive feature elimination, least absolute shrinkage, and selection operator (LASSO), and other artificial intelligence techniques were employed to identify the most salient features associated with predicting specific clinical outcomes for TAH occurrence.

Pre-transfusion creatinine, comorbidities of kidney and/or liver dysfunctions, and total transfused volume within 12 h (tV-12) per kg and per estimated total blood volume (eTBV) showed statistically significant differences between TAH and non-TAH groups. Multivariate analysis revealed the biggest factor in TAH occurrence was tV-12/kg followed by age of RBC units. The thresholds of risks were tV-12/kg of 30 ml/kg, tV-12/eTBV of 30%, and RBC unit age of 7.95 days.

The study findings suggest that the biggest factor on TAH occurrence is tV-12/kg. More importantly, 30% of eTBV transfusion could cause TAH in patients with multiple comorbidities.