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Case Reports
. 2025 Aug 27;30(25):104795.
doi: 10.1016/j.jaccas.2025.104795.

Torsades de Pointes Following Massive Transfusion Protocol: Case Highlighting Electrolyte Disturbances After Blood Product Administration

Mahir Khan  1 , Nawshin Kabir  2 , Shefali Mody  2 , Tasiyah Essop  2 , David Urciuoli  2
Affiliations
Case Reports

Torsades de Pointes Following Massive Transfusion Protocol: Case Highlighting Electrolyte Disturbances After Blood Product Administration

Mahir Khan et al. JACC Case Rep. .

Abstract

Background: Torsades de Pointes (TdP) is caused by QT-prolonging medications, electrolyte disturbances, structural heart disease, congenital long-QT syndromes, female gender, and age. If left untreated, it can lead to cardiac arrest and death.

Case summary: In this report, we highlight a case of TdP after the transfusion of massive blood products leading to electrolyte disturbances causing QT prolongation.

Discussion: This case underscores the need for careful electrolyte monitoring and QT assessment in patients receiving large-volume blood products, and refinement of guidelines regarding electrolyte monitoring and repletion posttransfusion.

Take-home messages: TdP is an often-fatal arrhythmia that can be caused by QT prolongation secondary to electrolyte disturbances. Massive blood transfusions can predispose patients to electrolyte depletion, QT prolongation, and TdP. Further refinement of guidelines regarding electrolyte monitoring and QT interval assessment is warranted to prevent complications such as TdP.

Keywords: QT prolongation; Torsades de Pointes; hypocalcemia; hypokalemia; hypomagnesemia; hypophosphatemia; massive transfusion protocol; ventricular arrhythmias.

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Conflict of interest statement

Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Electrocardiogram After Massive Transfusion Showing QTc Interval of 690
Figure 2
Figure 2
Admission Electrocardiogram Showing QTc Interval of 470
Visual Summary
Visual Summary
Hospital Course From Admission to Resolution of Arrhythmias Case of a middle-aged woman experiencing Torsades de Pointes, a life-threatening polymorphic ventricular tachycardia associated with prolonged QT interval, after massive blood product administration, resulting in rapid electrolyte imbalances such as hypocalcemia, hypokalemia, and hypomagnesemia. The patient ultimately made a full recovery, but her electrolyte monitoring strategy could have benefitted from improvement.
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