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Area of Science:

  • Transfusion Medicine
  • Cardiovascular Surgery
  • Pharmacology

Background:

  • Hypotensive transfusion reactions (HyTRs) are underreported and linked to angiotensin-converting enzyme inhibitors (ACEIs).
  • While bedside leukoreduction is less common, HyTRs persist in the prestorage leukoreduction era.
  • This study characterizes recent HyTR cases at an institutional level.

Purpose of the Study:

  • To describe recent cases of hypotensive transfusion reactions (HyTRs) at an academic medical institution.
  • To identify patient risk factors and transfusion characteristics associated with HyTRs in the prestorage leukoreduction era.

Main Methods:

  • Retrospective review of transfusion reaction records from January 2014 to April 2015.
  • HyTRs were defined using National Health Safety Network Hemovigilance Module criteria.
  • Analysis of patient demographics, surgical history, medication use (ACEIs), and extracorporeal circuit data.

Main Results:

  • Eleven HyTRs occurred in 10 adult patients (mean age 71.7 years), predominantly male.
  • All patients were taking ACEIs within 48 hours of the reaction and underwent major surgery, often cardiac or vascular.
  • Nine patients were on extracorporeal circuits; restarting implicated blood products led to recurrent hypotension.

Conclusions:

  • HyTRs in the prestorage leukoreduction era exhibit consistent patterns in at-risk patients.
  • Patients undergoing major surgery, especially with cardiopulmonary bypass, may benefit from preoperative ACEI management.
  • Consideration of earlier ACEI cessation or drug class switching is recommended for at-risk surgical patients.