Transfusion medicine
Transfusion reactions & complications

Topic Completed: 1 September 2011

Minor changes: 29 April 2021

Copyright: 2002-2021,, Inc.

PubMed Search: Hypotension blood transfusion [title]

Huy P. Pham, M.D., M.P.H.
Page views in 2020: 101
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Cite this page: Pham H. Hypotension. website. Accessed May 15th, 2021.
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
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