Reversible cerebral vasoconstriction syndrome following red blood cells transfusion: a case series of 7 patientsReport as inadecuate




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Orphanet Journal of Rare Diseases

, 10:47

First Online: 22 April 2015Received: 02 January 2015Accepted: 15 April 2015DOI: 10.1186-s13023-015-0268-z

Cite this article as: Liang, H., Xu, Z., Zheng, Z. et al. Orphanet J Rare Dis 2015 10: 47. doi:10.1186-s13023-015-0268-z

Abstract

BackgroundReversible cerebral vasoconstriction syndrome RCVS is an infrequent disease characterized by severe headaches with or without focal neurological deficits or seizures and a reversible vasoconstriction of cerebral arteries. The Orpha number for RCVS is ORPHA284388. However, RCVS triggered by blood transfusion is rare. Here we provided the clinical, neuroimaging and outcome data of patients diagnosed with RCVS resulting from red blood cells transfusion.

MethodsWe retrospectively identified 7 patients presenting with RCVS after red blood cells transfusion from January 2010 to May 2014. The information on clinical features, neuroimaging and outcome were collected and analyzed.

ResultsAll 7 patients were Chinese women, with a mean age of 42 years 38–46. All the patients had severe anemia Hb level < 6 g-dl caused by primary menorrhagia due to uterine myoma n = 5 or end-stage renal disease n = 2 and severe anemia persisted for a average period of 4 months 2–6. Each patient received packed red blood cells transfusion average: 1580 ml over a period of 2–5 days. Blood transfusion increased the hemoglobin level by at least 4.5 g-dL from baseline. The neurological symptoms appeared a mean of 6.3 days 2–13 after the last blood transfusion. Headache was the most frequent symptom and seizure, transient or persistent neurological disorders were observed. Neuroimaging showed cortical subarachnoid hemorrhage n = 2, focal intracerebral hemorrhage n = 2, localized brain edema n = 3, cerebral infarction n = 1, and posterior reversible encephalopathy syndrome n = 2. Cerebral vasoconstrictions were demonstrated by magnetic resonance angiography or cerebral angiography. Arterial constriction reversed in all patients within 1 to 3 months of follow-up after disease onset and no relapse was observed up to a mean of 17.1 ± 4.8 months of follow-up.

ConclusionsRCVS is a rare complication as a result of blood transfusion in patients with chronic severe anemia and should be considered in patients who show severe headache or neurologic deficits after transfusion.

KeywordsReversible cerebral vasoconstriction syndrome Blood transfusion Chronic anemia AbbreviationscSAHCortical subarachnoid hemorrhage

CSFCerebrospinal fluid

MMSEMini-mental status examination

PRBCsPacked red blood cells

PRESPosterior reversible encephalopathy syndrome

RCVSReversible cerebral vasoconstriction syndrome

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Author: Hui Liang - Ziqi Xu - Zhijun Zheng - Haiyan Lou - Wei Yue

Source: https://link.springer.com/







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