Transfusion Medicine - Hypotension due to transfusion

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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.

General
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● 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
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● 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

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

Prevention
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● Avoid bedside leukoreduction filters

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

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