Washed RBCs prevent recurrent acute hypotensive transfusion reactions

To examine whether a liver transplant patient, who was not taking an angiotensin-converting enzyme inhibitor and developed two episodes of hypotension with systolic pressure in the 50s within minutes of starting an RBC transfusion, may have had a disturbance in the production and metabolism of bradykinin and des-Arg(9)-BK. All patient information was obtained by reviewing the electronic medical record, the transfusion service database, and transfusion reaction investigation records. The blood pressure returned to normal once the transfusions were discontinued. In an effort to mitigate the acute hypotension, the blood products were washed. Subsequently, the patient received three additional packed RBC transfusions without further incidents of hypotension. Our experience suggests that washing the products was an acceptable and effective preventative measure to avoid further acute hypotensive transfusion reactions in patients unable to metabolize these vasodilators present in the donor units.