Hypotension and acute pulmonary insufficiency following transfusion of autologous red blood cells during surgery

A case report and review of the literature

R. B. Covin, D. R. Ambruso, K. M. England, M. R. Kelher, Z. Mehdizadehkashi, Lynn Boshkov, T. Masuno, E. E. Moore, F. J. Kim, Christopher C. Silliman

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)375-383
Number of pages9
JournalTransfusion Medicine
Volume14
Issue number5
DOIs
StatePublished - Oct 2004

Fingerprint

Erythrocyte Transfusion
Hypotension
Erythrocytes
Lung
Lipids
methionyl-leucyl-phenylalanine
Autologous Blood Transfusions
Respiratory Burst
Acute Lung Injury
Granulocytes
Immunoglobulins
Anti-Idiotypic Antibodies
Neutrophils

Keywords

  • Autologous transfusion
  • Lipids
  • Neutrophil priming
  • TRALI

ASJC Scopus subject areas

  • Immunology

Cite this

Hypotension and acute pulmonary insufficiency following transfusion of autologous red blood cells during surgery : A case report and review of the literature. / Covin, R. B.; Ambruso, D. R.; England, K. M.; Kelher, M. R.; Mehdizadehkashi, Z.; Boshkov, Lynn; Masuno, T.; Moore, E. E.; Kim, F. J.; Silliman, Christopher C.

In: Transfusion Medicine, Vol. 14, No. 5, 10.2004, p. 375-383.

Research output: Contribution to journalArticle

Covin, RB, Ambruso, DR, England, KM, Kelher, MR, Mehdizadehkashi, Z, Boshkov, L, Masuno, T, Moore, EE, Kim, FJ & Silliman, CC 2004, 'Hypotension and acute pulmonary insufficiency following transfusion of autologous red blood cells during surgery: A case report and review of the literature', Transfusion Medicine, vol. 14, no. 5, pp. 375-383. https://doi.org/10.1111/j.0958-7578.2004.00529.x
Covin, R. B. ; Ambruso, D. R. ; England, K. M. ; Kelher, M. R. ; Mehdizadehkashi, Z. ; Boshkov, Lynn ; Masuno, T. ; Moore, E. E. ; Kim, F. J. ; Silliman, Christopher C. / Hypotension and acute pulmonary insufficiency following transfusion of autologous red blood cells during surgery : A case report and review of the literature. In: Transfusion Medicine. 2004 ; Vol. 14, No. 5. pp. 375-383.
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