Hyperammonemia After Blood Transfusion
Authors: Zachary M. Rossfeld, Nathan R. Wright
Journal: Annals of Internal Medicine (2017)

Letters18 July 2017Hyperammonemia After Blood TransfusionZachary M. Rossfeld, MD and Nathan R. Wright, MDZachary M. Rossfeld, MDFrom The Ohio State University, Columbus, Ohio.Search for more papers by this author and Nathan R. Wright, MDFrom The Ohio State University, Columbus, Ohio.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0093 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: When clinicians transfuse blood products, they focus on ensuring donor–recipient compatibility and preventing reactions and communicable diseases. Less attention is paid to the progressive biochemical alterations that blood undergoes during storage.Objective: To highlight the potential harm from ammonia in stored blood products.Case Report: A 58-year-old man presented to the emergency department with chest pain and syncope. His history included coronary artery disease, type 2 diabetes mellitus, anemia, end-stage renal disease requiring intermittent hemodialysis, and cirrhosis due to nonalcoholic steatohepatitis. Home medications were aspirin, clopidogrel, atorvastatin, lactulose, midodrine, calcium acetate, cetirizine, sodium bicarbonate, and vitamin D3.Laboratory testing ...References1. Blei AT, Córdoba J; Practice Parameters Committee of the American College of Gastroenterology. Hepatic encephalopathy. Am J Gastroenterol. 2001;96:1968-76. [PMID: 11467622] CrossrefMedlineGoogle Scholar2. Apushkin M, Das A, Joseph C, Leung EK, Yeo KT, Baron JM, et al. Reducing the risk of hyperammonemia from transfusion of stored red blood cells. Transfus Apher Sci. 2013;49:459-62. [PMID: 23725795] doi:10.1016/j.transci.2013.05.002 CrossrefMedlineGoogle Scholar3. Lockwood AH. Blood ammonia levels and hepatic encephalopathy. Metab Brain Dis. 2004;19:345-9. [PMID: 15554426] CrossrefMedlineGoogle Scholar4. Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, et al. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60:715-35. [PMID: 25042402] doi:10.1002/hep.27210 CrossrefMedlineGoogle Scholar5. Clay AS, Hainline BE. Hyperammonemia in the ICU. Chest. 2007;132:1368-78. [PMID: 17934124] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From The Ohio State University, Columbus, Ohio.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L17-0093.This article was published at Annals.org on 13 June 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHyperammonemia After Blood Transfusion Bertrand Hermann , Dominique Thabut , and Nicolas Weiss Hyperammonemia After Blood Transfusion Zachary M. Rossfeld and Nathan R. Wright Hyperammonemia After Blood Transfusion Stephen M. Picca Metrics Cited byAssociation of Veterinary Hematology and Transfusion Medicine (AVHTM) Transfusion Reaction Small Animal Consensus Statement (TRACS). Part 1: Definitions and clinical signsAssociation of Veterinary Hematology and Transfusion Medicine (AVHTM) Transfusion Reaction Small Animal Consensus Statement (TRACS) Part 2: Prevention and monitoringHyperammonemia After Blood TransfusionBertrand Hermann, MD, Dominique Thabut, MD, PhD, and Nicolas Weiss, MD, PhDHyperammonemia After Blood TransfusionStephen M. Picca, MD 18 July 2017Volume 167, Issue 2Page: 143-144KeywordsAmmoniaBicarbonatesBloodBlood transfusionBrain diseasesCirrhosisHemoglobinHemorrhageLiverRed blood cells ePublished: 13 June 2017 Issue Published: 18 July 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...