Transfusion-Associated Hyperkalemic Cardiac Arrest in Neonatal, Infant, and Pediatric Patients

Morgan Burke, Pranava Sinha, Naomi L.C. Luban, Nikki Gillum Posnack

Research output: Contribution to journalReview articlepeer-review

17 Scopus citations


Red blood cell (RBC) transfusions are a life-saving intervention, with nearly 14 million RBC units transfused in the United States each year. However, the safety and efficacy of this procedure can be influenced by variations in the collection, processing, and administration of RBCs. Procedures or manipulations that increase potassium (K+) levels in stored blood products can also predispose patients to hyperkalemia and transfusion-associated hyperkalemic cardiac arrest (TAHCA). In this mini review, we aimed to provide a brief overview of blood storage, the red cell storage lesion, and variables that increase extracellular [K+]. We also summarize cases of TAHCA and identify potential mitigation strategies. Hyperkalemia and cardiac arrhythmias can occur in pediatric patients when RBCs are transfused quickly, delivered directly to the heart without time for electrolyte equilibration, or accumulate extracellular K+ due to storage time or irradiation. Advances in blood banking have improved the availability and quality of RBCs, yet, some patient populations are sensitive to transfusion-associated hyperkalemia. Future research studies should further investigate potential mitigation strategies to reduce the risk of TAHCA, which may include using fresh RBCs, reducing storage time after irradiation, transfusing at slower rates, implementing manipulations that wash or remove excess extracellular K+, and implementing restrictive transfusion strategies.

Original languageEnglish (US)
Article number765306
JournalFrontiers in Pediatrics
StatePublished - Oct 29 2021
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported by the National Institutes of Health (R01HL139472 to NP), Children’s National Heart Institute, Sheikh Zayed Institute for Pediatric Surgical Innovation, and the Children’s National Research Institute.

Funding Information:
The authors gratefully acknowledge Devon Guerrelli and Dr. Elizabeth Sherwin for assistance with Figure 1.

Publisher Copyright:
Copyright © 2021 Burke, Sinha, Luban and Posnack.


  • cardiac arrest
  • hyperkalemia
  • neonate
  • pediatric
  • red blood cell
  • red blood cell storage lesion
  • transfusion


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