Potassium Replacement Practices and Their Association With Blood Transfusion Outcomes in Surgical and Critical Care Patients: A Systematic Review

Abstract

This systematic review examines the association between potassium replacement strategies and blood transfusion outcomes in surgical and critical care settings. Despite the frequent use of potassium supplementation to address hypokalemia in hospitalized patients, its direct and indirect impact on transfusion requirements remains underrecognized. A structured literature search identified five eligible studies that investigated both potassium management and transfusion outcomes across diverse high-acuity populations. Findings revealed that aggressive or routine electrolyte monitoring and replacement may contribute to iatrogenic anemia through repeated phlebotomy, while preoperative hypokalemia was associated with increased need for transfusion in select cohorts. Although the degree of association varied, several studies suggested that individualized potassium replacement protocols could play a role in optimizing transfusion practices. These insights highlight the importance of integrated electrolyte and transfusion management to improve patient safety and conserve resources in perioperative and intensive care environments.

Keywords: blood transfusion; critical care; electrolyte imbalance; hemoglobin; hypokalemia; icu; perioperative management; potassium replacement; surgery; transfusion outcomes.

Figure 1. The PRISMA flowchart represents the study selection process.

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses