HYPOTENSIVE REACTIONS TO WHITE CELL-REDUCED PLASMA IN A PATIENT UNDERGOING ANGIOTENSIN-CONVERTING ENZYME-INHIBITOR THERAPY

Background: Hypotensive reactions to platelet transfusions performed w ith white cell (WBC)-reduction filters with negatively charged surface s have been reported recently in patients taking angiotensin-convertin g enzyme (ACE) inhibitors. Experimental studies have shown that the fi lter material can activate bradykinin, which may cause symptoms in pat ients with reduced bradykinin catabolism. Symptomatic adverse reaction s after the administration of fresh-frozen plasma (FFP) through a WBC- reduction filter have not been reported in a patient on ACE inhibitor medication. Case Report: A 58-year-old man with congenital coagulation factor V deficiency and hypertension treated with an ACE inhibitor wa s admitted for rehabilitation after orthopedic surgery. On 3 consecuti ve days, he received FFP through a WBC-reduction filter; within minute s of the beginning of each infusion, he experienced a drop in blood pr essure, facial erythema, abdominal pain, and anxiety. When the infusio ns were stopped, symptoms quickly abated without treatment. Multiple p rior transfusions of unfiltered FFP and FFP filtered through a WBC-red uction filter made by a different manufacturer, as well as subsequent transfusions of unfiltered FFP, had not produced such reactions. Concl usion: Facial flushing, hypotension, and abdominal pain after FFP admi nistration in a patient on ACE inhibitor medication appeared to be ass ociated with a specific type of WBC-reduction filter. This association and other reported studies suggest that special caution is warranted when patients who are treated with ACE inhibitors receive blood compon ents administered through WBC-reduction filters capable of generating bradykinin.