Prospective study of potassium-associated acute transfusion events in pediatric intensive care

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 (≥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.