A case of hyperkalemia after transfusion of irradiated red cell concentrate in mannitol-adenine-phosphate (RC-MAP)

A 72-year-old male, 45 kg in weight, underwent anterior and posterior fixations of the lumbar vertebra. Preanesthetic blood chemistry was within normal range. Following transfusion of 400 ml of RC-MAP in two hours (11 days after blood collection and 2 days after irradiation at a dose of 20 Gy), and then another 100 ml of 400 ml RC-MAP (12 days after blood collection and 2 days after irradiation at a dose of 20 Gy), the patient's serum kalium value increased from 4.8 to 5.5 mEq/l. Even though the transfusion was immediately discontinued, the level continued to rise to 6.0 mEq/l. It subsequently fell to the normal level with glucose-insulin therapy. The hyperkalemia in this case could have been attributable to the period of storage after irradiation, the transfusion of salvaged autologous blood, and the storage state of RC-MAP. However, since the kalium values of RC-MAP and the salvaged autologous blood were not measured in this case, the exact cause was unknown. In conclusion, hyperkalemia can occur in patients during transfusion of irradiated blood. Therefore, kalium levels should be monitored carefully. (author)