Logo American Journal of Case Reports

Call: 1.631.629.4328
Mon-Fri 10 am - 2 pm EST

Contact Us

Logo American Journal of Case Reports Logo American Journal of Case Reports Logo American Journal of Case Reports

29 October 2018 : Case report  USA

Intraoperative Diagnosis and Management of Acute Hypotensive Blood Transfusion Reaction (AHTR): A Report of Two Cases

Unusual clinical course, Challenging differential diagnosis, Diagnostic / therapeutic accidents

Uzung Yoon1E*, Madeel Abdullah1ABE, Elia Elia1DE, Jay Herman2ACDEF

DOI: 10.12659/AJCR.910642

Am J Case Rep 2018; 19:1283-1287

Abstract

BACKGROUND: Acute hypotensive transfusion reaction (AHTR) is characterized by the abrupt onset of hypotension immediately after the start of transfusion and usually resolves when transfusion ceases. Recent studies have shown an association with pre-operative treatment with an angiotensin-converting enzyme (ACE) inhibitor. This report presents two cases of AHTR in non-related patients and describes the diagnosis and management.

CASE REPORT: A 68-year-old woman underwent lumbar fusion surgery due to spinal stenosis and an 86-year-old man underwent a pancreaticoduodenectomy (Whipple’s procedure). Both patients had been treated pre-operatively with ACE inhibitors for hypertension. During surgery, both patients experienced acute profound intraoperative hypotension immediately after transfusion of packed red blood cells (RBCs). The blood transfusion was stopped immediately, and hemodynamic support was given with epinephrine, ephedrine, and phenylephrine. A diagnosis of acute hemolytic transfusion reaction was excluded by the direct antiglobulin test, serum hemolysis testing, exclusion of blood group mismatching, and a post-transfusion antibody screen. Other causes of hypotension were excluded. The two patients were confirmed t have had an AHTR, based on the current Centers for Disease Control and Prevention (CDC) criteria. In both cases, discontinuation of surgery was not possible, and surgery continued with intermittent hemodynamic support provided with catecholamines and vasopressin.

CONCLUSIONS: AHTR is a diagnosis of exclusion, based on laboratory and clinical findings. Antibody-mediated acute hemolytic transfusion reaction and any other causes of hypotension should be excluded as rapidly as possible. Patients who are at high risk of intraoperative bleeding might benefit from cessation of ACE inhibitors pre-operatively.

Keywords: Blood Group Incompatibility, bradykinin, Hemolysis, Hypotension

Add Comment 0 Comments

In Press

Case report  USA

Recognizing Exocrine Pancreatic Insufficiency in Patients with Diabetes: A Case Study

Am J Case Rep In Press; DOI: 10.12659/AJCR.948283  

Case report  Japan

An 88-Year-Old Woman with a 33-Year History of Idiopathic Portal Hypertension Presenting with Hepatocellula...

Am J Case Rep In Press; DOI: 10.12659/AJCR.947725  

Case report  Poland

Adult Hemophagocytic Lymphohistiocytosis (HLH) with Neurological Involvement: Diagnostic Complexities – A C...

Am J Case Rep In Press; DOI: 10.12659/AJCR.947694  

Case report  Switzerland

Surgical Approach to Littre's Hernia: A Rare Presentation of Meckel's Diverticulum

Am J Case Rep In Press; DOI: 10.12659/AJCR.947174  

Most Viewed Current Articles

21 Jun 2024 : Case report  China (mainland) 102,230

Intracranial Parasitic Fetus in a Living Infant: A Case Study with Surgical Intervention and Prognosis Anal...

DOI :10.12659/AJCR.944371

Am J Case Rep 2024; 25:e944371

0:00

07 Mar 2024 : Case report  USA 54,598

Neurocysticercosis Presenting as Migraine in the United States

DOI :10.12659/AJCR.943133

Am J Case Rep 2024; 25:e943133

0:00

20 Nov 2023 : Case report  Saudi Arabia 38,437

Azithromycin Treatment for Acne Vulgaris: A Case Report on the Risk of Clostridioides difficile Infection

DOI :10.12659/AJCR.941424

Am J Case Rep 2023; 24:e941424

0:00

07 Jul 2023 : Case report  Saudi Arabia 26,104

A Classical Case of Cesarean Scar Endometriosis in a 35-Year-Old Woman Presenting with Cyclical Abdominal P...

DOI :10.12659/AJCR.940200

Am J Case Rep 2023; 24:e940200

0:00

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923