Dilek YAZICIOĞLU, İlkay BARAN, Oya KALE, Gülten ÜTEBEY, Reyhan POLAT

YENİDOĞANDA MASİF ERİTROSİT TRANSFÜZYONUNA BAĞLI HİPERPOTASEMİ NEDENİYLE KARDİYOPULMONER ARREST

Amaç: Yenidoğanın masif transfüzyon protokollerinde öneriler; taze ve yıkanmış eritrosit kullanılması ile sınırlıdır. Bu yazıda, masif tansfüzyona bağlı hiperpotasemi nedeniyle kardiyopulmoner arrest gelişen bir yenidoğan sunulmaktadır. Olgu: İntrakraniyal kitle operasyonu planlanan 19 günlük bebeğin preoperatif hemoglobin (Hb) değeri 16 gr dL-1’idi. Transfüzyon için yıkanmış taze eritrosit, plazma ve trombosit hazırlandı. Maske indüksiyonunu takiben, 4 mL kg-1saat-1 %5dekstroz-1/4 izotonik [500 ml içerisinde 7 mEqL-1 potasyum(K+)] ile hidrasyon sağlandı. Radiyal arter ve subklaviyan ven kateterizasyonu, invazif basınç ve saatlik idrar çıkışı monitorizasyonu yapıldı. Masif kanama nedeniyle 1 saatte 250 mL eritrosit verilmesini takiben asistoli gelişti. Kardiyopulmoner resüsitasyona (KPR) başlandı. Kan gazları analizinde pH:7, 28, HCO3:20,6 mEqL-1, pO2:212 mmHg, pCO2: 24 mmHg, SaO2: %99,4, Na+: 138 mEqL-1, K+: 8,2 mEqL-1, Cl-: 107 mEqL-1, Glu:477 mg dL-1, Hb:12,5 gr dL-1 ölçüldü. Hiperpotasemi saptanan hastaya; kalsiyum glukonat, sodyum bikarbonat, furosemid ve glikoz/insülin infüzyonu yapıldı, KPR sürdürüldü. Spontan dolaşım 45. dakikada ancak glikoz/insülin bolusu yapıldıktan sonra başladı. Kontrol K+ değeri 6,9 mEqL-1 ölçüldü. Sonuç: Yenidoğanda taze ve yıkanmış eritrosit kullanılmasına rağmen masif transfüzyona bağlı hiperpotasemi gelişebilir. Hiperpotasemiye bağlı kardiyak arrest tedavisinde glikoz/insülin solüsyonunun bolus uygulanması etkin olabilir. Yenidoğanlarda masif transfüzyonda, transfüze edilen kanın içerisindeki potasyum düzeyinin ölçülerek hastaya verilen potasyum miktarının belirlenmesini ve replasman sıvısının potasyumsuz hazırlanmasını öneriyoruz.

HYPERKALEMIA RELATED CARDIAC ARREST AFTER MASSIVE TRANSFUSION IN THE NEWBORN

Objective: The recomendations for masive transfusion for the newborn are limited with the use of fresh, saline washed red blood cells (RBC). In this article we report a newborn with cardiopulmonary arrest related to hyperkalemia after masive transfusion. Case: A nineteen-days-old newborn was scheduled for intracranial mass surgery. The preoperative hemoglobin (Hb) level was 16 gr dL-1. Fresh, saline washed RBCs, fresh frozen plasma and platelets were prepared for transfusion. After inhalation induction the patient was hydrated with 4 mL kg-1h-1DW5-1/4NS (7 mEqL-1 K+ in 500 mL). Radial arterial and subclavian venous canulation and invasive pressure, urine output monitorization was made. Due to massive bleeding, 250 mL RBC was transfused in 1 hour. Since the patient experienced cardiac arrest, cardiopulmonary ressusitation (CPR) was initiated. Blood gas analysis revealed pH:7, 28, HCO3:20,6 mEqL-1, pO2:212 mmHg, pCO2: 24 mmHg, SaO2: %99,4, Na+: 138 mEqL-1, K+:8,2 mEqL-1, Cl-:107 mEqL-1, Glu:477 mg dL-1, Hb:12,5 gr dL-1. Calcium gluconate, furosemide, bicarbonate and glucose/insulin infusion was initiated for the treatment of hyperkalemia along with CPR. Circulation was restored 45 min after the administration of a bolus glucose/insulin. Control K+ level was 6,9 mEqL-1. Conclusion: In the newborn, despite the use of fresh, saline washed RBCs, masive transfusion can induce hyperkalemia related cardiac arrest. A bolus glucose/insulin may be effective to treat hyperkalemia related arrest. In the newborn, the K+level of the transfused blood should be measured and replacement fluids should be prepared without K+.

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