Hypotensive transfusion reactions can occur with blood products that are leukoreduced before storage.
BACKGROUND
Leukoreduction before storage, rather than bedside white blood cell filtration, is recommended to prevent hypotensive transfusion reactions.


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 degrees C. Bradykinin (BK) and des-Arg9-BK formation and degradation and the activity of kinin-degrading metallopeptidases were measured in plasma samples from both patients.


RESULTS
Degradation of des-Arg9-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.


CONCLUSIONS
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.
Canadian Blood Services, Ontario, Canada.
Donald M
DM
Arnold
Giuseppe
G
Molinaro
Theodore E
TE
Warkentin
Julie
J
DiTomasso
Kathryn E
KE
Webert
Ian
I
Davis
Lawrence
L
Lesiuk
Geoffrey
G
Dunn
Nancy M
NM
Heddle
Albert
A
Adam
Morris A
MA
Blajchman
D000230:Adenocarcinoma / Q000097:blood / Q000601:surgery; D000626:Aminopeptidases / Q000097:blood; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects* / Q000494:pharmacology; D016913:Blood Component Transfusion / Q000009:adverse effects*; D001793:Blood Preservation; D001804:Blood Transfusion, Autologous / Q000009:adverse effects*; D001920:Bradykinin / Q000031:analogs & derivatives* / Q000097:blood; D005374:Filtration; D006438:Hemodilution; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D007705:Kinins / Q000378:metabolism*; D007962:Leukocytes; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000601:surgery
D000806:Angiotensin-Converting Enzyme Inhibitors; D007705:Kinins; C024626:bradykinin, des-Arg(9)-; D000626:Aminopeptidases; C022750:X-Pro aminopeptidase; D001920:Bradykinin