Transfusion medicine
Tranfusion side effects
Hypotension due to transfusion

Author: Huy Phu Pham, M.D. (see Authors page)

Revised: 25 October 2017, last major update September 2011

Copyright: (c) 2002-2017,, Inc.

PubMed Search: Hypotension blood transfusion [title]

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Cite this page: Pham, H.P. Hypotension due to transfusion. website. Accessed January 19th, 2019.
Definition / general
  • 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