title: Hypotensive Transfusion Reaction Treated With Vasopressin in a Patient Taking an Angiotensin-Converting Enzyme Inhibitor: A Case Report.
abstract: Hypotensive transfusion reactions, which account for almost 3% of all transfusion reactions, are associated with patients treated with angiotensin-converting enzyme inhibitors. The current hypothesis suggests that they are caused by bradykinin-induced vasodilation in the absence of allergic, hemolytic, or septic mechanisms. The hypotension observed frequently is unresponsive to conventional therapy with catecholamines. The suggested intraoperative management includes cessation of transfusion and washing red blood cells before blood replacement. We present a patient experiencing a severe intraoperative hypotensive transfusion reaction, unresponsive to epinephrine and norepinephrine, in whom we were able to restore blood pressure and continue the transfusion of blood and plasma by infusing vasopressin.
authors.affiliation: From the *MEDNAX National Medical Group, Charlotte, North Carolina; and †Carolinas Healthcare System, Charlotte, North Carolina.
authors.forename: Richard
authors.initials: R
authors.lastname: Pollard
authors.forename: Meryn
authors.initials: M
authors.lastname: Boraski
authors.forename: Jared G
authors.initials: JG
authors.lastname: Block
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects*; D001795:Blood Pressure Determination; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007796:Laminectomy; D016343:Monitoring, Intraoperative / Q000379:methods; D010949:Plasma; D012307:Risk Factors; D013123:Spinal Fusion; D065227:Transfusion Reaction / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000009:adverse effects*; D014667:Vasopressins / Q000627:therapeutic use*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D014667:Vasopressins