Hyperkalaemia during massive blood transfusion in paediatric craniofacial surgery

Abstract

Children undergoing major craniofacial surgery (MCFS) often require transfusion in excess of one blood volume. Therefore they were the subject of a retrospective review which looked at the longitudinal trend of plasma potassium concentration [K+] during surgery. Ten of eleven children had a statistically significant increase in plasma potassium concentration during their intraoperative course and in five the potassium concentration exceeded 5.5 mmol · L-1. This was in contrast to the stable intraoperative plasma [K+] observed in a control group which did not receive blood transfusion. All MCFS children received a blood transfusion with red blood cell concentrates (RBCconc). The age of the units of RBCconc which had been transfused was 16.1 ± 8.4 days. The amount of extracellular potassium in 28 units of RBCconc was determined in order to estimate the amount of free potassium (Kdose) which the MCFS group received. The plasma [K+] in units of RBCconc < 1 week of age was < 20 mmol · L-1, whereas in units aged > 2 weeks it was > 40 mmol · L-1. The estimated Kdose was 0.2-1.6 mmol · kg-1. We concluded that the amount of extracellular potassium in units of RBCconc was clinically important and may give rise to hyperkalaemia during massive blood transfusion. © 1990 Canadian Anesthesiologists.