Complication

Cause

Management

Hypocalcemia

Citrate toxicity; citrate chelates calcium

IV calcium

Coagulopathy

Mostly dilutional; massive transfusion of PRBCs without platelets or plasma leads to loss of coagulation factors and platelets

Administration of other blood products (plasma, platelets, cryoprecipitate, or fibrinogen concentrate) in ratios or depending on laboratory results

Hypothermia

PRBCs are stored at 4 degrees Celsius; rapid infusion may decrease body temperature

Use of blood warmers, patient warming

Acid-base disturbances

– Metabolic alkalosis may be due to metabolism of citrate to bicarbonate

– Metabolic acidosis is rare (due to acid pH of blood products)

Supportive care

Hyperkalemia

Release of potassium from stored PRBCs (primarily in massive transfusions, in patients with impaired renal function, and in neonates)

Potassium monitoring; usual management