Hypotensive reactions associated with platelet transfusion through leukocyte reduction filters

This article reports a case of hypotensive reaction following platelet tran sfusion (PT) and presents a possible etiologic mechanism implicating negati vely charged leukocyte reduction filters (LRFs) and angiotensin converting enzyme (ACE) inhibitors. A 14-year-old boy with acute lymphoblastic leukemi a was admitted to the pediatric intensive care unit (PICU) for respiratory failure following bone marrow transplantation. He was being treated with AC E inhibitors and was hemodynamically stable. He received a PT with a negati vely charged bedside LRF the day his ACE inhibitor dose was doubled. His bl ood pressure (BP) dropped from 106/65 to 75/45. The PT was stopped and his BP was stabilized with a bolus of cristalloid. The same PT was restarted us ing a macroaggregate filter and his BP remained stable. This reaction was c haracterized by severe and isolated hypotension. It occurred while using a negatively charged bedside LRF in a patient who had a recent increase in AC E inhibitor therapy. The reaction did not recur when the LRF was replaced b y a macroaggregate filter. This case provides further evidence to support t he hypothesis that the use of negatively charged LRF may lead to hypotensiv e transfusion reactions in some patients. Bradykinin, which is generated wh en plasma is exposed to a negatively charged surface, and whose metabolism is decreased by ACE inhibitors, may play a role in these reactions.