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Letters |18 July 2017

Hyperammonemia After Blood Transfusion

Zachary M. Rossfeld, MD; Nathan R. Wright, MD

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This article was published at Annals.org on 13 June 2017.
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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 revealed a hemoglobin level of 67 g/L and an international normalized ratio of 1.5. We administered 1 unit of packed red blood cells collected 17 days earlier and diagnosed non–ST-segment elevation myocardial infarction. We hospitalized the patient, and his treatment included intravenous heparin, metoprolol, vitamin K, ondansetron, and pantoprazole. Therapy with his home medications was continued.
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Rossfeld ZM, Wright NR. Hyperammonemia After Blood Transfusion. Ann Intern Med. ;167:143–144. doi: 10.7326/L17-0093

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Published: Ann Intern Med. 2017;167(2):143-144.

DOI: 10.7326/L17-0093

Published at www.annals.org on 13 June 2017

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2017 American College of Physicians
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