Transfusion double whammy? Adrenaline‐takotsubo‐anaphylaxis‐Kounis complex post transfusion?

Abstract

Background and Objectives: The adrenaline-takotsubo-anaphylaxis-Kounis, or the ATAK complex, where there are clinical and pathophysiological overlaps between takotsubo and Kounis syndromes, in which histaminergic, adrenergic and other mediators may play roles, was recently described. The objective of this report was to describe three cases where the ATAK complex was suspected to have occurred after transfusion.Materials and Methods: Three cases were recently reported to the New Zealand Blood Service haemovigilance programme that appeared to have features in common suggestive of the ATAK complex.Results: All three patients had had a blood component transfused, an initial severe allergic reaction, treatment with adrenaline or a congener, subsequent acute left ventricular failure or transfusion-associated circulatory overload, and features suggestive of takotsubo cardiomyopathy.Conclusions: Although rarely described, transfusion-associated ATAK complex may be occurring more often than believed. Circumstances during a transfusion may predispose to it. It should be suspected if the sequence of events described above occur. Its characteristics need to be better understood. Risk factors for it may be modifiable.

ATAK Complex (Adrenaline, Takotsubo, Anaphylaxis, and Kounis Hypersensitivity-Associated Coronary Syndrome) after COVID-19 Vaccination and Review of the Literature

“…When the sinus rhythm stabilized, the patient was subjected to an electrocardiogram that showed mild ST elevation in the anterior precordial leads and T wave changes; moreover, alterations of left ventricular apex kinesis were seen in echocardiography and normal coronary arteries were detected with coronary angiography [ 48 ]. In 2022, three patients experienced anaphylactic events after blood component transfusion [ 49 ]; in 2019, a 60-year-old female with a history of insulin-dependent diabetes mellitus, hypertension, chronic kidney disease, and multiple myeloma (MM) presented chest pain and dyspnea during treatment with anti-CD38 antibodies (daratumumab). A sinus rhythm with biphasic T waves in V2 and V3, along with deep T wave inversions in V4 through V6 (suggestive of Wellens syndrome) was detected with an ECG, and apical and anteroseptal akinesis were revealed by an echocardiogram (a previous echocardiogram performed 3 months before was normal).…”

The transfusion-associated dyspnea prospective observation and laboratory assessment study: a protocol for investigating and disambiguating cardiopulmonary and high-grade febrile transfusion reactions in adults

“…[1][2][3][4][5][6] CRTRs may also incur the direct upper and lower airway and/or cardiovascular effects of an allergic bronchopulmonary or anaphylaxis response. 7,8 Furthermore, CRTRs may occur downstream of the multi-system effects of a bacterially contaminated or incompatible product or its pyrogenic mediators. [9][10][11] Taken together, CRTRs account for the majority of transfusion-related fatalities, though their true scope in all-cause morbidity and mortality remains unknown.…”