We just had a patient that was treated with plasma due to a a reaction to ace inhibitors.  Does anyone know of a reference to support this use of the product?  Thanks!!

 

 

Did it work? I have never heard of this.

There is an abstract on PubMed about this - just googled it.

Edited April 24, 201411 yr by David Saikin

We do have a regular patient who comes in for FFP transfusions to treat her angioedema.  It seems to be the only thing that works for her to relieve her symptoms.  But this isn't for any type of reaction, this is a regular occurrence for her.

I have also heard of FFP being used to treat this.  If I remember correctly, it's also important in patients undergoing surgery because the lack of the enzyme prevents them coming round from the anaesthetic.  But I might be mixing it up with something else

Sorry - I was talking rubbish.  I was thinking of plasma cholinesterase deficiency.  I need a coffee!!

I finally found an article with some information on uptodate.com - ACE inhibitor-induced angioedema. Our patient was treated with 2 units of FP24, Epinephrine, Solu-medrol, Benadryl aand Zantac. He was admitted and is doing better.

BTW, There is a very interesting article in  Monday's "CAP Today"  about ACE inhibitors and hypotensive transfusion reactions.  

This is starting to be a treatment used here.  Does anyone know if the C1 esterase inhibitor levels in 5 day thawed plasma are comparable to those in recently thawed FFP (24 hr expiration)?  I need to know whether we can used our Thawed Plasma for these patients (who apparently may have either hereditary angioedema or angioedema as a reaction to ACE inhibitors).

Questioned this use of FFP a couple times when I was involved in transfusion appropriateness review at my previous hospital - medical director always approved it, apparently it was a valid method of treatment. Do not remember details of why, unfortunately.

Did a new article come out recently? 

I have never seen this before and we have had 3 patients in the last 10 days!!  One was hereditary angioedema and 2 were on ACE inhibitors.  Our pathologists have never heard of it either.

Several years ago (circa 2005) we had two sisters who would report to ER for anywhere between 8 and 12 units of FFP to treat their hereditary angioedema. Their symptoms were facial and airway swelling. We treated them as genuine emergency situations whenever they appeared. They had a brother who asphyxiated due to the disease. No recombinant product or other purified C1 esterase inhibitor product was available to us. The plasma worked but we were always worried about volume overload. No adverse effect was ever reported to us. We did discover that the sisters had been enrolled in a trial for some sort of inhibitor replacement product. They felt that it did not work so they came to us for plasma infusion. 

When our in-house transfusion guidelines were first developed we were instructed to use freshly thawed plasma, not 5-day thawed plasma, for these patients. Our pathologist had a reference but I'd have to do some digging to find it. 

There have been several angioedema-related articles published in _Transfusion_ over the years. They have mainly been related to hereditary forms or acquired forms (but not drug-related, to the best of my recollection). Have not heard about this in relation to ACE inhibitors, however.