Hypotensive transfusion reactions can occur with blood products that are leukoreduced before storage

Abstract

Hypotensive reactions can occur with blood products that are LR before storage and non-LR ANH. An inherent defect in the metabolism of kinins may be a risk factor for the development of hypotensive transfusion reactions.

The Development of a Novel Molecular Assay Examining the Role of Aminopeptidase P Polymorphisms in Acute Hypotensive Transfusion Reactions

“…As such, the generation of bradykinin could not have been attributable to leukocyte filtration in these cases. 9 In summary, this study represents the first attempt to our knowledge to characterize acute hypotensive transfusion reactions by a polymorphism in the APP gene, XPNPEP2. Our assay was fully successful in sequencing the XPNPEP2 gene to identify the C-2399A SNP in control populations.…”

“…[3][4][5][6][7][8][9][10][11] These drugs are frequently implicated in acute hypotensive transfusion reactions because of the important role ACE plays in bradykinin degradation. However, a number of acute hypotensive transfusion reactions have been reported in patients not taking ACEIs.…”

“…3 Some studies have also shown that bradykinin accumulation and hypotensive episodes may be exacerbated in transfused patients taking angiotensin-converting enzyme (ACE) inhibitors (ACE-Is), because ACE is a key enzyme in the degradation of bradykinin. [3][4][5][6][7][8][9][10][11] However, based on reports of acute hypotensive transfusion reactions occurring in the absence of ACE-I use, 5,12 it is possible that other pathways may contribute to the accumulation of bradykinin and/or their metabolites and result in hypotension in the setting of transfusion.…”

“…15 In fact, several studies have demonstrated that the C-2399A SNP in XPNPEP2 is associated with decreased APP activity and angioedema in selected populations. [14][15][16] To date, however, few studies have investigated the role of APP in acute hypotensive transfusion reactions, 9,11 and no studies have determined whether the C-2399A SNP may be a contributing factor to acute hypotensive transfusion reactions in patients not taking ACE-Is.…”

Experimental prestorage filtration removes antibodies and decreases lipids in RBC supernatants mitigating TRALI in vivo

“…These filters are designed for prestorage LR of RBC units and have nothing to do with bedside filtration or any of the adverse reactions that such a process may impart. 46 One may question why prestorage filtration should be employed if lipids accumulate during routine storage reaching a relative maximum at outdate. The observed diminution of the lipid bioactivity, specifically 5-HETE, was not anticipated and may be attributable to binding of the enzymes required for its generation from AA.…”