SHM Converge Scientific Abstract ePoster Gallery-A Case of Fatal Angioedema With Blood Transfusion in a Patient Taking Ace-I.

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This case report describes a fatal episode of angioedema in a 48-year-old African American woman with obesity, hypertension, and chronic menorrhagia who was taking enalapril, an ACE inhibitor. She was admitted for severe anemia (hemoglobin 6.3 g/dL) and required blood transfusion. Due to antibodies, transfusion was delayed for nearly 12 hours, but she eventually received two units of packed red blood cells.<br /><br />The first unit was tolerated without complication. About 15 minutes into the second unit, she developed throat numbness and tongue swelling that progressed rapidly. Despite treatment with epinephrine, diphenhydramine, and steroids, her swelling worsened, leading to dyspnea, hypoxia, and failed attempts at endotracheal intubation because of severe edema. She then suffered cardiac arrest, required emergency cricothyroidotomy, and achieved return of spontaneous circulation after CPR. However, her condition deteriorated over the next several days with shock liver, acute renal failure, septic shock, and severe anoxic brain injury. She later suffered another cardiac arrest on day 7 and died despite resuscitation attempts.<br /><br />The authors note that blood transfusions can cause allergic transfusion reactions, including angioedema, and ACE inhibitors are independently associated with angioedema. They suggest that the combination of ACE inhibitor use and transfusion may increase the risk of severe hypersensitivity reactions in susceptible patients, although evidence is limited. The report urges clinicians to be cautious when transfusing patients on ACE inhibitors and calls for further research into possible mechanisms behind this association.

Asset Subtitle

Ariba K. Akhund

Meta Tag

Author List Ariba K. Akhund, NNG Hafsa

Category Clinical Vignettes

Concept Blood Transfusion

Concept Allergic Transfusion Reaction

Concept Angioedema

Concept Anaphylactic Shock

Concept ACE Inhibitor

Distinguished Non-Finalist

Presenter Organization LIJ Forest Hills Hospital, Northwell

Presenting Author Ariba K. Akhund

Track Adult

Keywords

angioedema

ACE inhibitor

enalapril

blood transfusion

allergic transfusion reaction

tongue swelling

airway obstruction

cricothyroidotomy

anaphylaxis

severe anemia

Blood Transfusion

Allergic Transfusion Reaction

Angioedema

Anaphylactic Shock

ACE Inhibitor