Abstract
Acute Hypotensive Transfusion Reaction in a Patient Taking Angiotensin Converting Enzyme Inhibitors Therapy: A Case Report and Literature Review
Highlights
Acute hypotension is one of the most common and striking manifestation of transfusion reactions caused by contamination of blood products, acute hemolysis, transfusion-associated lung injury, and anaphylaxis [1]
The hypothesis centers around the increased levels of the vasoactive peptide, Bradykinin (BK), that occurs in a transfusion recipient after the blood or blood product makes contact with a negatively charged leukoreduction filter [2, 5,6,7]
BK exerts its hypotensive effects through the BK-2 receptors intravascularly causing systemic hypotension via profound vasodilitation, especially in patients taking Angiotensin Converting Enzyme Inhibitors (ACEi) therapy [1, 9] (Figure 1)
Summary
Acute hypotension is one of the most common and striking manifestation of transfusion reactions caused by contamination of blood products, acute hemolysis, transfusion-associated lung injury, and anaphylaxis [1]. The patient had a baseline anemia and demonstrated notable pulse pressure variation on A-line and as a result transfusion with FFP and pRBCs in citrate-phosphatedextrose-adenine (CPDA) in a 1:1 ratio was initiated via rapid transfuser set after the induction of general anesthesia. At this moment, the patient quickly became hypotensive (Mean Arterial Pressure – MAP fell to below 30mmHg, MAP 95mmHg immediately prior). Mean arterial pressure (MAP) and heart rate (HR) monitoring every 15 minutes before and after #1 and #2 transfusion of 2units of Packed Red Blood Cells and 2 units of Fresh Frozen Plasma through Belmont Rapid Transfuser causing AHTR episodes and treated with IV Epinephrine respectively.
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