Hyperkalemia is a known complication of blood transfusion in neonates. Hyperkalemia may also complicate transfusion in older pediatric patients, especially if certain risk factors are present.
Patient selection: pediatric patient receiving a transfusion
The hyperkalemia should occur within 12 hours after completion of the transfusion.
The median age in the study of Yamada et al was 1.28 years.
Risk factors for hyperkalemia:
(1) irradiation of the red cell blood product
(2) hemolytic anemia and/or hemolytic transfusion reaction
(3) the presence of multiple serious comorbid conditions, including impaired renal function
(4) red cells that have been stored for some time
(5) massive transfusion, typically for trauma
(6) medications interfering with renal excretion of potassium
The diagnosis of transfusion-associated hyperkalemia requires exclusion of pseudohyperkalemia associated with a hemolyzed specimen, especially a finger stick.
Some suggested solutions to prevent hyperkalemia:
(1) measure the potassium concentration in red cell products prior to crossmatch
(2) washing the red cells prior to transfusion
