Hypotensive Reactions Associated with Platelet Transfusions and Angiotensin‐Converting Enzyme Inhibitors

Abstract

Preliminary findings suggest a new type of transfusion reaction associated with the use of negatively charged leukocyte reduction filters during platelet transfusions to patients on ACE inhibitors.

Hypotensive transfusion reactions in the era of prestorage leukoreduction

“…In this study, 37% of the patients had undergone cardiac surgery. This is consistent with several other reports that linked CABG with HyTRs, mainly in patients receiving ACEi . It has been shown that CPB results in increased BK production and impaired metabolism .…”

Signs and symptoms associated with the transfusion of WBC‐reduced RBCs and non‐WBC‐reduced RBCs in patients with anemia and HIV infection: results from the Viral Activation Transfusion Study

“…This is generally attributed to the higher levels of cytokines in the stored platelet products, especially those that have not undergone prestorage WBC reduction 60 . Hypotension has also been associated with the use of negatively charged WBC‐reduction filters and sometimes with positively charged filters during platelet transfusions to patients taking angiotensin‐converting enzyme inhibitors, possibly because of the release of bradykinin 61,62 . As noted previously here, the relevance of cytokine accumulation to reactions that accompany RBC transfusion is unclear, as it is not clear whether the levels of IL‐1, IL‐2, IL‐6, IL‐8, and TNF in stored RBC units are sufficiently high to cause hypotension.…”

Leukocyte-Reduced Products

“…[163][164][165][166][167][168][169][170] Although the reported incidence of these reactions is relatively low and is decreasing as fewer products are transfused using bedside filtration, some reactions have been severe and illustrate an interesting phenomenon. [163][164][165][166][167][168][169][170] Although the reported incidence of these reactions is relatively low and is decreasing as fewer products are transfused using bedside filtration, some reactions have been severe and illustrate an interesting phenomenon.…”

“…165 The vasodilatory effect of bradykinin was studied in several experimental settings. Pulmonary kininases rapidly degrade bradykinin, thereby preventing its effect on the arterial circulation.…”