Repeated cardiac arrests caused by transfusion-related hyperkalemia and massive bleeding : A case report

ABSTRACT

Transfusion-related hyperkalemic cardiac arrest (TRHCA) is a serious complication of administration of packed red blood cell (P-RBC). We present a case of repeated TRHCAs in a 13 month-old girl, who was undergoing intra-abdominal huge mass excision. There were three consecutive TRHCAs during the operation. The first (11.7 mM of K+) and the second (9.5 mM of K+) cardiac arrests were successfully resuscitated. However, the last cardiac arrest (8.9 mM of K+) was failed to be recovered with conventional treatment. Risk factors of TRHCA such as hypocalcemia, hypoxemia, acidosis, hyperglycemia, hyperlactatemia, and low cardiac out state were combined. The transfused P-RBCs were all irradiated. In this situation, processing of P-RBC using an autotransfusion device before the transfusion should be considered to prevent hyperkalemia in addition to conventional treatment of TRHCA.