Hypotensive Transfusion Reactions in Patients Taking Angiotensin-Converting–Enzyme Inhibitors

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Abstract
Noninfectious adverse events from blood transfusion are relatively common. They range from febrile, nonhemolytic reactions and mild allergic reactions to serious hemolytic and anaphylactic reactions.1 Hypotensive reactions to transfusion are less well recognized.2,3 They involve unexpected severe hypotension after the administration of blood through a bedside leukoreduction filter in patients taking angiotensin-converting–enzyme (ACE) inhibitors. I report a series of eight patients ( Table 1 ) who had such reactions during a five-month period at a tertiary care hospital. During this period, 5527 units of red cells and 2206 random-donor platelet concentrates were transfused; universal leukoreduction with use of bedside filters had recently been adopted.4