NEONATAL-MORTALITY FOLLOWING TRANSFUSION OF RED-CELLS WITH HIGH PLASMA POTASSIUM LEVELS

The death of a neonatal infant following cardiac surgery and the trans fusion of packed red cells (RBCs) with high plasma potassium levels is reported. The patient had been diagnosed at 2 weeks of age as having multiple cardiac malformations. During cardiopulmonary bypass surgery, multiple units of packed RBCs less than 5 days old were transfused. I n response to a ''stat'' order and after depletion of stock units prep ared for neonatal usage, a 32-day-old unit of packed RBCs was issued f or transfusion. After approximately 60 mL was rapidly transfused from this unit, the patient experienced cardiac arrest. Serum potassium con centration after transfusion and before death was 8.9 mmol per L. Plas ma potassium concentration in the remainder of the transfused packed R BC unit was approximately 60 mmol per L. A model was created to calcul ate the posttransfusion plasma potassium concentration, and close corr elation was found between the model and the observed potassium concent ration, which assumes that the potassium load had not yet been distrib uted to the extravascular and intracellular fluid compartments. It is concluded that the transfusion of relatively large volumes of RBCs be limited to fresh packed RBCs or to packed RBCs that have been saline w ashed, to minimize the complications of electrolyte disturbances.