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Paroxysmal atrial fibrillation caused by hypokalemia in a healthy donor who underwent PBSC apheresis

Bone Marrow Transplantation volume 48, pages 155–156 (2013)Cite this article

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The mobilization of PBSC is generally safe but not completely risk free. Pulsipher1 reported 0.6% of serious and unexpected adverse events (AEs) in unrelated donors of PBSC. A review of EBMT reported an incidence of 7.25 severe AEs per 10 000 donations; the cardiac events consisted of four cardiac arrests in the BM donor group and two myocardial infarctions in the peripheral blood (PB) donor group of a total of 51 400 donations.2

We report a case of paroxysmal atrial fibrillation (PAF) in a female sibling donor who underwent PBSC apheresis (PBSCa). The donor, aged 50 years and weighing 55 kg, with an unremarkable medical history, was subjected to assessments in accordance with the standards SIMTI-GITMO and IBMDR for PBSC donors.3, 4 Physical tests, electrolytes, thrombophilic screening, thyroid function, electrocardiography (ECG) with effort tolerance and echocardiography were normal. The serum human chorionic gonadotropin level was negative. G-CSF was administered at a dose of 10 μg/kg/day s.c. with minimal bone pain. The PBSC collection started from day +4, when the flow cytometric CD34+ cell count in PB was more than 20 cells/μL. The procedure was carried out using COM. TEC. (Fresenius HEMO CARE) in 3 h and 50 min, during which 8028 mL of blood (2.11 blood volume) was processed. A total of 3 × 106 CD34+/kg recipient weight was collected. A volume of 594 mL of acid citrate dextrose-A (ACD-A) was used during PBSCa. For the appearance of lip numbness, 1 fl Ca-gluconate was infused, which resulted in resolution of symptoms secondary to hypocalcemia. Monitoring of blood pressure and heart rhythm during and after the procedure were normal. Laboratory investigations performed 3 h after the end of the procedure (Table 1) showed hypokalemia (K+=2.9 mEq/L, normal range: 3.5 and 5.0 mEq/L). The donor was discharged from the Day Hospital with indication to take potassium chloride orally at a dose of 1200 mg two times daily and monitoring of serum potassium levels the following day. However, about 10 h after the end of PBSCa, the donor showed an episode of micturition syncope associated with PAF. For the persistence of hypokalemia (K+=2.9 mEq/L), in the Emergency Room of our Hospital, 40 mEq of potassium chloride was infused intravenously, which resulted in the restoration of sinus rhythm. The subsequent monitoring of serum potassium levels, the ECGs seriated in the following days and the ECG Holter were normal. For the severe adverse event, we decided to exclude the donor from further PBSCa.

Table 1 Laboratory tests performed before and after PBSCa
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Acknowledgements

We thank Sandra Zaccheo for technical assistance.

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Authors and Affiliations

  1. Clinical Division of Haematology and BMT Unit, ‘A. Perrino’ Hospital, Brindisi, Italy

    G Loseto, G Mele & G Quarta

  2. Unit of Immunology and Transfusion Medicine, ‘A. Perrino’ Hospital, Brindisi, Italy

    D Canaris, C Battista & F Cucci

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  1. G Loseto
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Correspondence to G Loseto.

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Loseto, G., Canaris, D., Mele, G. et al. Paroxysmal atrial fibrillation caused by hypokalemia in a healthy donor who underwent PBSC apheresis. Bone Marrow Transplant 48, 155–156 (2013). https://doi.org/10.1038/bmt.2012.109

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