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Hypotensive transfusion reactions can occur with blood products that are leukoreduced before storage
Author(s) -
Arnold Donald M.,
Molinaro Giuseppe,
Warkentin Theodore E.,
DiTomasso Julie,
Webert Kathryn E.,
Davis Ian,
Lesiuk Lawrence,
Dunn Geoffrey,
Heddle Nancy M.,
Adam Albert,
Blajchman Morris A.
Publication year - 2004
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.0041-1132.2004.04057.x
Subject(s) - leukoreduction , medicine , bradykinin , blood transfusion , anesthesia , white blood cell , surgery , gastroenterology , receptor
BACKGROUND: Leukoreduction before storage, rather than bedside white blood cell filtration, is recommended to prevent hypotensive transfusion reactions. STUDY DESIGN AND METHODS: Investigation of hypotensive transfusion reactions during radical prostatectomy in two patients on angiotensin‐converting enzyme inhibitors. In Patient A, hypotension occurred during the transfusion of each of the following blood products: 2 units of autologous blood deposited and leukoreduced (LR) before storage; 3 units of allogeneic red cells LR before storage; and 2 units of non‐LR acute normovolemic hemodilution (ANH) whole blood. When each of the transfusions was stopped, the blood pressure recovered. In Patient B, hypotension occurred during the transfusion of non‐LR ANH whole blood. All implicated units were administered rapidly using a blood infuser at 37°C. Bradykinin (BK) and des‐Arg 9 ‐BK formation and degradation and the activity of kinin‐degrading metallopeptidases were measured in plasma samples from both patients. RESULTS: Degradation of des‐Arg 9 ‐BK was severely impaired and the activity of aminopeptidase P severely reduced in Patient A, but not in Patient B. BK degradation was mildly impaired in both patients. CONCLUSION: 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.