Anti-hypertensive and transfusion related hypotension

 Q: Which of the following antihypertensive agents may have a direct synergistic effect during blood transfusion reactions? (select one)

A) ACE-Inhibitors (ACE-I)
B) B-blocker (BB)
C) Calcium channel blockers (CCB)
D) Diuretics 
E) Vasodilators


Answer: A

The synergistic effect of blood product transfusion and ACE-I causing hypotension is blamed on increased bradykinin levels in the transfused product. Some experts have suggested holding ACE-I for 24 hours before blood product transfusion, but evidence to use this practice is weak. It occurs mostly with platelet transfusion. It is also reported during apheresis procedures.

Primary hypotensive transfusion reaction is an exclusive transfusion reaction associated only with hypotension. It is not a part of other transfusion reactions like acute hemolytic reaction, transfusion-related acute lung injury (TRALI), and anaphylaxis.

#hemodynamic

References:

1. Metcalf RA, Bakhtary S, Goodnough LT, Andrews J. Clinical Pattern in Hypotensive Transfusion Reactions. Anesth Analg 2016; 123:268.

2. Owen HG, Brecher ME. Atypical reactions associated with use of angiotensin-converting enzyme inhibitors and apheresis. Transfusion 1994; 34:891.

3.  Hume HA, Popovsky MA, Benson K, et al. Hypotensive reactions: a previously uncharacterized complication of platelet transfusion? Transfusion 1996; 36:904.