29 October 2018
: Case report
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 Herman2ACDEFDOI: 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
SARS-CoV-2/COVID-19
22 February 2023 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.938732
22 February 2023 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.938761
16 March 2023 : Case report
Am J Case Rep 2023; 24:e938359
01 March 2023 : Case report
Am J Case Rep 2023; 24:e937955
In Press
17 Mar 2023 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.939411
17 Mar 2023 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.939474
16 Mar 2023 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.938752
15 Mar 2023 : Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.938875
Most Viewed Current Articles
13 Jul 2022 : Case report
DOI :10.12659/AJCR.936441
Am J Case Rep 2022; 23:e936441
06 Dec 2021 : Case report
DOI :10.12659/AJCR.934406
Am J Case Rep 2021; 22:e934406
23 Feb 2022 : Case report
DOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250
07 Dec 2021 : Case report
DOI :10.12659/AJCR.934347
Am J Case Rep 2021; 22:e934347