Washed RBCs prevent recurrent acute hypotensive transfusion reactions

Area of Science:

• Cardiovascular Medicine
• Transfusion Medicine
• Pharmacology

Background:

• Liver transplant recipients may have altered drug metabolism.
• Hypotensive reactions during transfusion are a concern.
• Bradykinin plays a role in blood pressure regulation.

Observation:

• A liver transplant patient experienced severe hypotension (systolic pressure in the 50s) during two separate packed red blood cell (RBC) transfusions.
• The patient was not taking an angiotensin-converting enzyme inhibitor.
• Hypotension resolved upon transfusion cessation.

Findings:

• Washing the RBC products before transfusion was implemented to mitigate hypotension.
• The patient subsequently received three additional packed RBC transfusions without recurrence of hypotensive episodes.
• This suggests a potential issue with the metabolism of vasodilators present in donor RBC units.

Implications:

• Washing RBC products can be an effective preventative strategy for acute hypotensive transfusion reactions.
• This approach may benefit patients with impaired metabolism of vasoactive substances transfused with RBCs.
• Further investigation into bradykinin metabolism in transfusion reactions is warranted.