Hypotension and acute pulmonary insufficiency following transfusion of autologous red blood cells during surgery: a case report and review of the literature

Transfusion of autologous blood is associated with fewer complications, although all untoward events of transfusion may not be negated with this strategy. We report a case of acute pulmonary insufficiency and hypotension following transfusion of autologous packed red blood cells (PRBCs) in a patient...

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Bibliographic Details
Published in:Transfusion medicine (Oxford, England) England), 2004-10, Vol.14 (5), p.375-383
Main Authors: Covin, R. B., Ambruso, D. R., England, K. M., Kelher, M. R., Mehdizadehkashi, Z., Boshkov, L. K., Masuno, T., Moore, E. E., Kim, F. J., Silliman, C. C.
Format: Article
Language:English
Subjects:
Adenocarcinoma - surgery
autologous transfusion
Blood Transfusion, Autologous - adverse effects
Humans
Hypotension - etiology
Intraoperative Care
lipids
Lung Diseases - etiology
Male
Middle Aged
neutrophil priming
Postoperative Complications
Prostatectomy
Prostatic Neoplasms - surgery
TRALI
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Summary:Transfusion of autologous blood is associated with fewer complications, although all untoward events of transfusion may not be negated with this strategy. We report a case of acute pulmonary insufficiency and hypotension following transfusion of autologous packed red blood cells (PRBCs) in a patient, who was undergoing major surgery. Anti‐HLA class‐I and class‐II and anti‐granulocyte antibodies were measured in the unit and in the recipient. Neutrophil (PMN)‐priming activity was measured as the augmentation of the formyl‐Met‐Leu‐Phe‐activated respiratory burst. No immunoglobulins were identified; however, significant lipid‐priming activity was present in the implicated, autologous PRBC unit that primed PMNs from both healthy people and the recipient. In addition, lipids, identical to those that accumulate during PRBC storage, caused significant hypotension when infused into rats at similar concentrations found in stored PRBCs. We conclude that the observed transfusion‐related acute lung injury reaction with significant hypotension may be the result of two independent events: the first is related to inherent host factors, in this case major surgery, and the second is the infusion of lipids that accumulate during the routine storage of PRBCs.
ISSN:0958-7578
1365-3148
DOI:10.1111/j.0958-7578.2004.00529.x