Reactions to rapid infusion of stable plasma protein solution during large volume plasma exchange

Five per cent heat treated stable plasma protein solution (SPPS) has been rapidly infused into 25 patients, as fluid replacement during large volume plasmapheresis. Reactions were produced in 20 patients. Subjective symptoms of flushing, nasal stuffiness, fullness and throbbing in the head, colicky abdominal pain, metallic taste or apprehension were observed in 16 patients, and 11 patients became hypotensive with an average systolic pressure of 70 mm Hg. These observations support earlier reports of hypotension due to rapid SPPS infusion, and document the occurrence of subjective symptoms which may be the harbingers of a hypotensive reaction. In view of the known presence of a bradykinin-like substance in some heat treated plasma protein solutions, hypotension during SPPS infusion should be interpreted with caution in the light of these findings.