Which electrolyte disturbance is commonly associated with massive transfusion requiring correction?

Which electrolyte disturbance is commonly associated with massive transfusion requiring correction?

• A. Hypercalcemia
• B. Hypocalcemia
• C. Hyperkalemia
• D. Hyponatremia

Answer: (B)

During massive transfusion, a large amount of citrate-containing preserved blood is given as an anticoagulant. The citrate rapidly binds ionized calcium in the recipient, reducing the free calcium available for critical functions like cardiac contraction and vascular tone. If the transfusion is very rapid or the patient’s liver metabolism of citrate is overwhelmed, citrate can accumulate and drive ionized calcium even lower, leading to hypocalcemia. This drop in calcium can contribute to hypotension, cardiac instability, and arrhythmias, so calcium replacement is often needed as part of the resuscitation. Hypercalcemia is not typically expected in this scenario, since the issue is calcium being bound and sequestered by citrate rather than being in excess. Hyponatremia isn’t a primary concern in the context of massive transfusion, and while hyperkalemia can occur from storage-related potassium leakage, hypocalcemia from citrate is the more characteristic and commonly corrected disturbance in this setting.

During massive transfusion, a large amount of citrate-containing preserved blood is given as an anticoagulant. The citrate rapidly binds ionized calcium in the recipient, reducing the free calcium available for critical functions like cardiac contraction and vascular tone. If the transfusion is very rapid or the patient’s liver metabolism of citrate is overwhelmed, citrate can accumulate and drive ionized calcium even lower, leading to hypocalcemia. This drop in calcium can contribute to hypotension, cardiac instability, and arrhythmias, so calcium replacement is often needed as part of the resuscitation.

Hypercalcemia is not typically expected in this scenario, since the issue is calcium being bound and sequestered by citrate rather than being in excess. Hyponatremia isn’t a primary concern in the context of massive transfusion, and while hyperkalemia can occur from storage-related potassium leakage, hypocalcemia from citrate is the more characteristic and commonly corrected disturbance in this setting.