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Health Equity Curriculum for Anesthesia Residents
OA-SPA Ask the Expert - October 2024
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Question of the Day
A 24-year-old G1P0 woman with a twin gestation at 38 weeks EGA presents for caesarean section following failed induction of labor. She develops significant postpartum hemorrhage and is resuscitated with 6U PRBC, 2U FFP, 1U cryoprecipitate, and 1U platelets. Which of the following changes in potassium and pH would you MOST expect after massive transfusion?
Explanation
As red blood cells are stored, changes occur in the hydrogen ion concentration and potassium levels. Stored red blood cells contain an increased concentration of hydrogen ions leading to a lower pH. In addition, the potassium level increases in stored red blood cells over time. PRBCs may contain greater than 20-30 meq/L depending on the length of storage time. Studies in trauma patients have demonstrated increased potassium levels after transfusions and a high incidence of hyperkalemia in patient’s receiving greater than seven units of PRBCs. The increased hydrogen ion concentration and increased potassium levels are the result of biochemical reactions that occur during storage of PRBCs. During storage, glucose is metabolized to lactate, the concentration of hydrogen ions increase, and the plasma becomes acidotic. PRBCs are stored at 1-6 oC and at this temperature, activity of the sodium-potassium pump increases leading to increased plasma potassium levels.
References:
Kim P, Chin-Yee I, Eckert K, Malthaner RA, Gray DK. Hemolysis with rapid transfusion systems in the trauma setting. Can J Surg. 2004;47(4):295-297. Aboudara MC, Hurst FP, Abbott KC, Perkins RM. Hyperkalemia after packed red blood cell transfusion in trauma patients. J Trauma. 2008;64(2 Suppl):S86-S91. doi:10.1097/TA.0b013e318160c0b8 Blood Product ModificationsMiller RD. Miller’s Anesthesia, 5th ed. Philadelphia, PA: Churchill Livingstone; 1999: Ch. 61, pp. 1830-1867.
OA Series: October 2024
35:32
OA Global Health Equity Ask the Expert
Health Equity Curriculum for Anesthesia ResidentsSamuel Percy, MD, Children's Hospital Colorado
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