Chloride-induced increase of plasma potassium after transfusion of erythrocytes in dialysis patients.
The transfusion of packed red cells (PRC), though they are depleted in cellular potassium, is thought to result in an increase of serum potassium when transfused to patients on regular hemodialysis treatment. The aim of this study was to prove this hypothesis when transfusion was performed during the dialysis-free interval. The effect of 21 transfusions of 2 units of PRC once washed with 0.9% NaCl was analyzed in 10 anemic patients. A significant increase of plasma potassium from 5.5 to 5.9 mmol/l was observed. Intracellular sodium and potassium after transfusion reflected a mixing of the patients' endogenous and the transfused red cells. However, the excess of cellular chloride introduced by the washing procedure, which was by 27.6 mmol/l higher in the transfused cells, could not be detected in the mixed cell population after transfusion. The rapid chloride shift from the transfused acid red cells into plasma, which is accompanied by a rapid uptake of bicarbonate, is thought to release an equivalent amount of potassium, most likely from muscle or bone and enhances plasma potassium. Transfusion of PRC in the dialysis-free interval seems to be no risk for patients with a plasma potassium below 5 mmol/l. Alternatives are transfusion during dialysis or addition of 20 mmol sodium bicarbonate, when transfusion is performed in the dialysis-free interval.
D000328:Adult; D001803:Blood Transfusion; D002712:Chlorides / Q000097:blood / Q000494:pharmacology*; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood*; D006435:Renal Dialysis
D002712:Chlorides; D011188:Potassium