Home   Chapter Home   Jobs   Conferences   Fellowships   Books


Transfusion medicine

Tranfusion side effects

Hypotension due to transfusion

Reviewer: Huy Phu Pham, M.D. (see Reviewers page)
Revised: 5 November 2011, last major update September 2011
Copyright: (c) 2007-2011, PathologyOutlines.com, Inc.


● Defined as hypotension during the transfusion with no signs of transfusion reaction (such as shortness of breath, fevers, chills, flushing, or urticaria)
● Sudden decrease in systolic or diastolic pressure of at least 30 mmHg
● May be due to activation of contact coagulation pathway and release of bradykinin (Transfusion 2007;47:410)
● Associated with ACE inhibitors (ACE breaks down bradykinin in circulation) and some filters which activate contact pathway (J Heart Lung Transplant 2001;20:759)
● Most commonly seen with bedside negative-charged leukoreduction filters for platelet transfusions in patients receiving ACE inhibitors
● Rare in pediatric ICU (4 events per 2509 transfusions, Transfusion 2006;46:1899)

Clinical features

● Sudden decrease in systolic or diastolic pressure of at least 30 mmHg within 1 hour of the initiation of transfusion
● Hypotension tends to resolve after transfusion is stopped
● Must rule out TRALI and various transfusion reactions: hemolytic, allergic, anaphylactic


● Immediate treatment required
● Stop the transfusion
● Maintain IV access
● Supportive care: put patient in Trendelenburg position (head down, feet up) and give fluids


● Avoid bedside leukoreduction filters

End of Transfusion Medicine > Tranfusion side effects > Hypotension due to transfusion

This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.

All information on this website is protected by copyright of PathologyOutlines.com, Inc. Information from third parties may also be protected by copyright. Please contact us at [email protected] with any questions (click here for other contact information).