A patient receiving an angiotensin converting enzyme (ACE) inhibitor may experience an anaphylactoid reaction with hypotension when undergoing extracorporeal blood processing.


Pathogenesis: Kininogen may be activated by exposure to negatively-charged surfaces of an artificial blood processing filter, resulting in formation of bradykinin. ACE inhibitors inhibit kininase II, which delays bradykinin metabolism and results in increased plasma levels.



(1) transfusion of blood through leukocyte reduction filter

(2) hemodialysis

(3) apheresis

(4) plasma exchange

(5) Staphylococcal protein A affinity absorption


Clinical findings:

(1) hypotension

(2) bradycardia

(3) flushing

(4) dyspnea


Prevention: ACE inhibitors should be stopped 24-48 hours prior to exposure.


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