We report a girl who developed severe and fatal
hyperkalemia following rapid and massive
blood transfusion during surgery. She was 7-year-old, 20-kg in weight, and received wide resection of the femoral bone with custom
prosthesis implant because of malignant femoral
osteosarcoma. During the procedure,
bleeding was active and profuse and amounted to about 3,000 mL in 4 h, eventuating in
shock. Despite rapid transfusion with 15 units of packed red blood cells (RBC) still she remained hypotensive and
hypovolemic. When we switched to give her whole blood, actually 100 mL having been given, widening of QRS complex followed immediately by
cardiac arrest developed.
Cardiopulmonary resuscitation although started at once was unsuccessful. At this juncture, arterial blood gas analysis showed
acidosis and severe
hyperkalemia (10.3 mmol/L), possibly resulting from transfusion of blood of older storage. The case reminded us once again the importance and necessity of the use of
potassium-low blood component (fresh, saline-washed RBCs) in case of massive and rapid
blood transfusion especially in pediatric patients with
hypovolemia and
low cardiac output.