Hypertensive crises following platelet transfusions in a patient on erythropoietin therapy.

A marked increase in blood pressure was observed Introduction immediately after operation, needing the institution of more intensive antihypertensive therapy (Figure 1). The mechanism by which recombinant human erythroThe patient was discharged 12 days later, with her poietin (Epo) increases blood pressure in a substantial blood pressure controlled with captopril 100 mg/day. proportion of uraemic patients is still unclear. In vitro Five days later, she was readmitted for peritoneal studies support changes in endothelial function [1,2]. dialysis treatment. Her blood pressure was Increased vascular responsiveness to endogenous vaso140/80 mmHg. Because of peritoneal outflow obstrucconstrictors has also been shown in uraemic patients tion, omental wrapping of the catheter was suspected receiving Epo [3,4]. and a laparatomy was performed. One hour prior to We previously observed that antiplatelet therapy laparatomy six platelet packs were transfused, the may protect these patients from the development of patient again developing severe hypertension, which hypertension induced by Epo [5,6 ]. One hypothesis to did not respond to analgesic or anxiolytic drugs explain this finding may be the influence of hyperactive (Figure 1). platelets on the function of an abnormal endothelium. In order to rule out the influence of volume expanWe study the effect of Epo in an end-stage renal sion on the hypertensive crises following platelet transfailure patient with severe thrombocytopenia and fusions, 350 ml of saline 0.9% (the estimated plasma the changes in her blood pressure after platelet transfusions.