Hypotensive transfusion reactions in the era of prestorage leukoreduction

Abstract

Leukoreduction in blood units could prevent patients undergoing transfusions from transfusion-associated adverse reactions (TAARs) such as febrile nonhemolytic transfusion reactions (FNHTRs). However, the effect of prestorage and poststorage leukoreduction on TAARs and its underlying mechanisms in stored blood components remains to be determined. Therefore, we investigated the impact of prestorage leukocyte-reduced (pre-LR) and poststorage leukocyte-reduced (post-LR) blood products, including red blood cells (RBCs) and apheresis platelets (PHs), on the incidence of FNHTRs and other TAARs in patients who received transfusions from 2009 to 2014 in a tertiary care center. We also investigated the difference of leukocyte-related bioactive mediators between pre-and post-LR blood components. The results indicated that prevalence of TAARs was significantly reduced in the transfusions of pre-LR blood components. Particularly, the prevalence of FNHTRs was significantly reduced in the pre-LR RBC transfusions and the prevalence of allergy reactions was markedly reduced in the pre-LR PH transfusions. Furthermore, in vitro evaluation of cytokines in the pre-and post-LR blood components revealed that IL-1β, IL-8 and RANTES levels were significantly elevated in the post-LR RBCs during the storage. In contrast, IL-1β, IL-6 and IL-8 levels were significantly elevated in the post-LR PHs during the storage. These findings suggested that prestorage leukoreduction had a diminishing effect on the development of TAARs, which could be associated with less accumulation of cytokines in the stored blood components. www.impactjournals.com/oncotarget/

Red blood cell microvesicles activate the contact system, leading to factor IX activation via 2 independent pathways

“…In a broader sense, whether blood transfusion routinely leads to contact activation in vivo also has not been established. However, hypotensive transfusion reactions occur despite prestorage leukoreduction, 48 likely because of excess bradykinin formation resulting from PKa-mediated cleavage of HK. We postulate that RBC-MVs that promote PK activation also represent potential triggers for posttransfusion generation of kinins, which may play a role in some inflammatory reactions to RBC transfusion.…”

Irradiation and prolonged storage of red cells are associated with increased adverse events

“…Although an allergic reaction is considered a type of inflammation, its pathophysiological mechanism is IgE‐mediated hypersensitivity to certain allergens, which are relatively stable during storage or irradiation. Hypotensive reactions are considered to be caused by bradykinin release in association with bedside leukoreduction filters, and/or prevention of bradykinin breakdown due to use of angiotensin‐converting enzyme inhibitors . We cannot rule out the possibility that some hypotensive reactions are actually an atypical manifestation of a systemic inflammatory response; however, the total number of this type of reaction was low in this study.…”

Incidence of hypotension and acute hypotensive transfusion reactions following platelet concentrate transfusions

“…Although changes in leucoreduction practices have resulted in a significant decrease in the incidence of acute hypotensive transfusion reactions , events are still reported . Storage of PCs appears to enhance BK production .…”