Hyperammonemia After Blood Transfusion
Authors: Bertrand Hermann, Dominique Thabut, Nicolas Weiss
Journal: Annals of Internal Medicine (2018)

Letters20 February 2018Hyperammonemia After Blood TransfusionBertrand Hermann, MD, Dominique Thabut, MD, PhD, and Nicolas Weiss, MD, PhDBertrand Hermann, MDGroupe Hospitalier Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, Sorbonne Université, and Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (B.H., D.T., N.W.)Search for more papers by this author, Dominique Thabut, MD, PhDGroupe Hospitalier Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, Sorbonne Université, and Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (B.H., D.T., N.W.)Search for more papers by this author, and Nicolas Weiss, MD, PhDGroupe Hospitalier Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, Sorbonne Université, and Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (B.H., D.T., N.W.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0639 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We read Rossfeld and Wright's (1) case report about a 58-year-old cirrhotic man who developed an episode of hyperammonemic overt hepatic encephalopathy (HE) after blood transfusion with interest. The authors suggest that ammonia contained in the 3 units of packed red blood cells may be responsible for the episode, especially because of their long storage time. Although we agree with the diagnosis of HE, we believe that transfusion is unlikely to have caused it.First, packed red blood cells contain little ammonia. The authors estimate the amount to be approximately 3 g, which is very low compared ...References1. Rossfeld ZM, Wright NR. Hyperammonemia after blood transfusion. Ann Intern Med. 2017;167:143-4. [PMID: 28605806]. doi:10.7326/L17-0093 LinkGoogle Scholar2. Romero-Gómez M, Grande L, Camacho I. Prognostic value of altered oral glutamine challenge in patients with minimal hepatic encephalopathy. Hepatology. 2004;39:939-43. [PMID: 15057897] CrossrefMedlineGoogle Scholar3. Ditisheim S, Giostra E, Burkhard PR, Goossens N, Mentha G, Hadengue A, et al. A capillary blood ammonia bedside test following glutamine load to improve the diagnosis of hepatic encephalopathy in cirrhosis. BMC Gastroenterol. 2011;11:134. [PMID: 22151412] doi:10.1186/1471-230X-11-134 CrossrefMedlineGoogle Scholar4. Brassier A, Gobin S, Arnoux JB, Valayannopoulos V, Habarou F, Kossorotoff M, et al. Long-term outcomes in ornithine transcarbamylase deficiency: a series of 90 patients. Orphanet J Rare Dis. 2015;10:58. [PMID: 25958381] doi:10.1186/s13023-015-0266-1 CrossrefMedlineGoogle Scholar5. Pantham G, Post A, Venkat D, Einstadter D, Mullen KD. A new look at precipitants of overt hepatic encephalopathy in cirrhosis. Dig Dis Sci. 2017;62:2166-73. [PMID: 28560484] doi:10.1007/s10620-017-4630-y CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Groupe Hospitalier Pitié Salpêtrière, Assistance Publique Hôpitaux de Paris, Sorbonne Université, and Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (B.H., D.T., N.W.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L17-0639. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHyperammonemia After Blood Transfusion Zachary M. Rossfeld and Nathan R. Wright Hyperammonemia After Blood Transfusion Stephen M. Picca Hyperammonemia After Blood Transfusion Zachary M. Rossfeld and Nathan R. Wright Metrics 20 February 2018Volume 168, Issue 4Page: 305-306KeywordsAmmoniaBloodBlood transfusionDisclosureGlutamineHemorrhageMedical dialysisProteinsRed blood cellsUrea ePublished: 20 February 2018 Issue Published: 20 February 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...