Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Jan 6, 2017; 6(1): 53-56
Published online Jan 6, 2017. doi: 10.5527/wjn.v6.i1.53
Severe hyperkalemia following blood transfusions: Is there a link?
Christos V Rizos, Haralampos J Milionis, Moses S Elisaf
Christos V Rizos, Haralampos J Milionis, Moses S Elisaf, Department of Internal Medicine, Medical School, University of Ioannina, 45110 Ioannina, Greece
Author contributions: All authors contributed equally in data acquisition, analysis and interpretation of the data, drafting and critical revision of the manuscript.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at University Hospital of Ioannina.
Informed consent statement: The patient involved in this study gave his written informed consent authorizing use and disclosure of his protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Moses S Elisaf, MD, FASA, FRPSH, Professor of Medicine, Department of Internal Medicine, Medical School, University of Ioannina, Stavros Niarchos Avenue, 45110 Ioannina, Greece. egepi@cc.uoi.gr
Telephone: +30-26-51007509 Fax: +30-26-51007016
Received: September 7, 2016
Peer-review started: September 8, 2016
First decision: September 30, 2016
Revised: October 6, 2016
Accepted: October 22, 2016
Article in press: October 24, 2016
Published online: January 6, 2017
Abstract

Patients with gastrointestinal bleeding often require large volume blood transfusion. Among the various side effects of blood transfusion, the increase of potassium levels is a serious one which is often overlooked. We report a case of severe hyperkalemia in a patient with gastric bleeding after large volume transfusion of packed red blood cells. The patient had hyperkalemia at baseline associated with his receiving medication as well as acute renal failure following hypovolemia. The baseline hyperkalemia was further aggravated after massive transfusions of packed red blood cells in a short period of time. The associated pathogenetic mechanisms resulting in the increase of potassium levels are presented. A number of risk factors which increase the risk of hyperkalemia after blood transfusion are discussed. Moreover, appropriate management strategies for the prevention of blood transfusion associated hyperkalemia are also presented. Physicians should always keep in mind the possibility of hyperkalemia in cases of blood transfusion.

Keywords: Hyperkalemia, Blood transfusions, Packed red blood cells, Renal function, Gastrointestinal bleeding

Core tip: Blood transfusion is associated with a wide range of potential complications. Among them, the increase of serum potassium levels is sometimes overlooked. Hyperkalemia is a potential deadly complication, especially when the patient has already increased potassium levels at baseline. A number of pathogenetic mechanisms associated with the development of hyperkalemia in patients receiving transfusions are discussed in the present case report. Moreover, the necessary precautions for minimizing the risk of transfusion-induced hyperkalemia are also presented.