Which of the following is the least likely complication after massive blood transfusion:

Answer is D (Metabolic Acidosis) Massive blood transfusion is usually associated with metabolic alkalosis rather than metabolic acidosis Hyperkalemia, Citrate toxicity and Hypothermia are established complications of massive blood transfusion Metabolic acidosis / Alkalosis after Massive Blood Transfusion Banked / stored blood is acidic because of accumulated red cell metabolites. However the actual acid load to the patient is minimal. The acid load on massive blood transfusion is quickly countered by the effect of citrate infusion as citrate is normally metabolized to sodium bicarbonate. It is therefore more common for massively transfused patients to exhibit metabolic alkalosis rather than metabolic acidosis. Patients with massive transfusion may present with initial metabolic acidosis, however metabolic alkalosis is more frequent once citrate is metabolized in liver to bicarbonate.