Acute Hypotensive Transfusion Reaction in a Patient Taking Angiotensin Converting Enzyme Inhibitors Therapy: A Case Report and Literature Review

Acute Hypotensive Transfusion Reaction (AHTR) is characterized by the sudden onset and isolated drop in blood pressure which resolves a few minutes after discontinuing the transfusion without additional therapy. The pathogenesis of this reaction is generated by an increase in Bradykinin (BK), a state which may be encouraged by use of an Angiotensin Converting Enzyme Inhibitor (ACEi). We report a case of acute and severe hypotension in a patient on ACEi therapy that we hypothesized to be an AHTR based upon the following evidence: The symptomatology presentation at the time of the transfusion, the negative laboratory workup for other common culprits, and the tolerance of subsequent transfusions after stopping the ACEi. While the discontinuation of an ACEi when thought to be contributory to an AHTR has been recommended, to the best of our knowledge, we describe the first reported case of a likely AHTR evident where this was implemented and successful in a surgical setting. Herein we detail our patient's possible AHTR event and following medical course, the rational for our conclusion and clinical actions, and a review of the recent AHTR literature.