A Rare Case of Intraoperative Transfusion-associated Hypotension in a Chinese Pregnant Patient.

Background: Transfusion-associated hypotension (TAH) is characterized by the abrupt onset of hypotension immediately after the start of transfusion and usually resolves when transfusion ceases. The pathogenesis of TAH is not yet fully understood.

Methods: A 36-year-old woman underwent exploratory laparotomy and cesarean section due to cervical squamous cell carcinoma. During surgery, the patients experienced acute, profound intraoperative hypotension within 5 minutes after the initiation of the prestorage leukocyte-reduced suspension red blood cells (RBC) transfusion. A series of laboratory tests confirmed TAH. The patient then underwent a successful blood transfusion and operation. TAH can occur in all types of blood components under various conditions. The literature surrounding the incidence of TAH differs widely from 0.03 to 2.13 in 10,000.

Conclusions: This is the first case report of TAH in an intraoperative pregnant woman in China, neither associated with prestorage leukocyte-reduced RBC nor irrelevant to ACE inhibitors. Some biological response mediators (BRMs) and acute phase reactive proteins might play a role in this case. Understanding the etiology and the pathophysiology of TAH facilitates proper management, leading to improved transfusion safety.