Blood transfusion may be complicated by hyperammonemia in a patient with end-stage liver disease. Ammonia may accumulate during the storage of red blood cells and this can represent a significant load when multiple units are transfused.
Clinical features:
(1) The patient has end-stage liver disease with hepatic encephalopathy.
(2) The patient receives a blood transfusion.
(3) There is a rise in the blood ammonia concentration.
(4) The patient may develop an altered mental status.
(5) The rise in ammonia cannot be explained by another cause.
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