Pulseless electrical activity after rapid administration of fresh frozen plasma.

We present two extreme low birthweight preterm neonates who developed pulseless electrical activity during dilutional exchange transfusions with fresh frozen plasma (FFP). Both were polycythaemic recipient twins delivered prematurely because of foetal compromise as a result of twin-to-twin transfusion syndrome. The two events were associated with an acute fall in ionised calcium. We discuss the mechanism of these cardiac arrests and highlight the care required when infusing citrate containing blood products, particularly FFP, in order to avoid causing acute life-threatening hypocalcaemia.