Pseudohyperkalemia in pediatric patients with newly diagnosed hematological malignancies.

IF 1.2 4区 医学 Q4 HEMATOLOGY
Pediatric Hematology and Oncology Pub Date : 2024-10-01 Epub Date: 2024-06-12 DOI:10.1080/08880018.2024.2362157
Ting-Chu Li, Wei-Cheng Chan, Ming-Chin Tsai, Shang-Feng Tsai, Sheng-Ling Jan, Lin-Shien Fu, Fang-Liang Huang, Yung-Chieh Huang
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Abstract

Patients with newly diagnosed hematological malignancies often present with a considerable cellular burden, leading to complications including hyperkalemia. However, pseudohyperkalemia, arising from in vitro cell lysis, can pose challenges in clinical practice. Although pseudohyperkalemia is frequently reported in adult hematological malignancies, its occurrence in pediatric patients is underreported, and its incidence in this demographic remains unclear. We retrospectively reviewed the medical records of pediatric patients who received a new diagnosis of hematological malignancies from 2011 to 2022 at Taichung Veterans General Hospital. Hyperkalemia was defined by a serum or plasma potassium level exceeding 5.5 mEq/L. Pseudohyperkalemia was defined by 1) a potassium decrease of over 1 mEq/L in within 4 h without intervention or 2) the absence of electrocardiography changes indicative of hyperkalemia. Cases with apparent red blood cell hemolysis were excluded. A total of 157 pediatric patients with a new diagnosis of hematological malignancies were included, 14 of whom exhibited hyperkalemia. Among these 14 cases, 7 cases (4.5%) were of pseudohyperkalemia. This rate increased to 21.2% in patients with initial hyperleukocytosis. Pseudohyperkalemia was associated with a higher initial white blood cell count and lower serum sodium level. All episodes of pseudohyperkalemia occurred in the pediatric emergency department, where samples were obtained as plasma, whereas all true hyperkalemia cases were observed in the ordinary ward or intensive care unit, where samples were obtained as serum. Timely recognition of pseudohyperkalemia is crucial to avoiding unnecessary potassium-lowering interventions in pediatric patients with newly diagnosed hematological malignancies.

新确诊血液恶性肿瘤儿科患者的假性高钾血症。
新确诊的血液恶性肿瘤患者通常会出现大量细胞负荷,导致包括高钾血症在内的并发症。然而,体外细胞裂解产生的假性高钾血症会给临床实践带来挑战。虽然假性高钾血症在成人血液恶性肿瘤中经常被报道,但其在儿科患者中的发生率却报道不足,而且其在这一人群中的发生率仍不清楚。我们回顾性地查看了台中荣民总医院 2011 年至 2022 年期间新诊断为血液恶性肿瘤的儿科患者的病历。高钾血症的定义是血清或血浆钾水平超过 5.5 mEq/L。假性高钾血症的定义是:1)4 小时内血钾下降超过 1 mEq/L,且未采取干预措施;或 2)无提示高钾血症的心电图变化。有明显红细胞溶血的病例被排除在外。共纳入 157 例新诊断为血液恶性肿瘤的儿科患者,其中 14 例表现为高钾血症。在这 14 例中,7 例(4.5%)为假性高钾血症。在最初出现高白细胞症的患者中,这一比例增至 21.2%。假性高钾血症与初始白细胞计数较高和血清钠水平较低有关。所有假性高钾血症病例都发生在儿科急诊室,采集的样本都是血浆,而所有真正的高钾血症病例都发生在普通病房或重症监护室,采集的样本都是血清。及时识别假性高钾血症对于避免对新诊断为血液恶性肿瘤的儿科患者进行不必要的降钾干预至关重要。
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来源期刊
CiteScore
2.60
自引率
5.90%
发文量
71
审稿时长
6-12 weeks
期刊介绍: PHO: Pediatric Hematology and Oncology covers all aspects of research and patient management within the area of blood disorders and malignant diseases of childhood. Our goal is to make PHO: Pediatric Hematology and Oncology the premier journal for the international community of clinicians and scientists who together aim to define optimal therapeutic strategies for children and young adults with cancer and blood disorders. The journal supports articles that address research in diverse clinical settings, exceptional case studies/series that add novel insights into pathogenesis and/or clinical care, and reviews highlighting discoveries and challenges emerging from consortia and conferences. Clinical studies as well as basic and translational research reports regarding cancer pathogenesis, genetics, molecular diagnostics, pharmacology, stem cells, molecular targeting, cellular and immune therapies and transplantation are of interest. Papers with a focus on supportive care, late effects and on related ethical, legal, psychological, social, cultural, or historical aspects of these fields are also appreciated. Reviews on important developments in the field are welcome. Articles from scientists and clinicians across the international community of Pediatric Hematology and Oncology are considered for publication. The journal is not dependent on or connected with any organization or society. All submissions undergo rigorous peer review prior to publication. Our Editorial Board includes experts in Pediatric Hematology and Oncology representing a wide range of academic and geographic diversity.
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