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Anomaly of the des‐Arg 9 ‐bradykinin metabolism associated with severe hypotensive reactions during blood transfusions: a preliminary study
Author(s) -
Cyr M.,
Hume H.A.,
Champagne M.,
Sweeney J.D.,
Blais C.,
Gervais N.,
Adam A.
Publication year - 1999
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1046/j.1537-2995.1999.39101084.x
Subject(s) - enalaprilat , bradykinin , platelet , medicine , metabolism , in vivo , enzyme , chemistry , angiotensin converting enzyme , endocrinology , pharmacology , immunology , biochemistry , ace inhibitor , biology , blood pressure , receptor , microbiology and biotechnology
BACKGROUND: Severe hypotensive reactions have been described after the transfusion of platelets or red cells through negatively‐charged bedside white cellreduction filters. The possibility of a role for bradykinin (BK) in the genesis of these reactions has been raised. STUDY DESIGN AND METHODS: To understand if an anomaly of BK metabolism is associated with these reactions, the metabolism of BK and des‐Arg 9 ‐BK was studied in the sera of four patients who presented with a severe hypotensive transfusion reaction. Tests were performed in the absence and the presence of complete in vitro inhibition of angiotensin‐converting enzyme (ACE) activity by enalaprilat. RESULTS: In the presence of ACE inhibition (enalaprilat), the half‐life (t½) of BK measured in the sera of patients who presented with a severe hypotensive transfusion reaction (361 ± 90 sec) was not significantly different from that measured in the sera of normal controls (249 ± 16 sec). In the presence of ACE inhibition (enalaprilat), the t½ of des‐Arg 9 ‐BK was significantly greater in patients who presented with a severe hypotensive transfusion reaction (1549 ± 319 sec) than in normal controls (661 ± 38 sec) (p<0.001). CONCLUSION: A metabolic anomaly mainly affecting the degradation of des‐Arg 9 ‐BK could be responsible for its accumulation in vivo. Des‐Arg 9 ‐BK could be responsible, at least in part, for severe hypotensive transfusion reactions.