A syndrome of hypertension, convulsion, and cerebral haemorrhage in thalassaemic patients after multiple blood-transfusions.

Various combinations of hypertension, convulsion, severe headache, and cerebral haemorrhage appeared in eight thalassaemic patients after they had received 3--7 units of blood in preparation for splenectomy. Intracranial haemorrhage definitely developed in four patients, three of whom died. At necropsy the brains showed changes similar to those of hypertensive cerebral haemorrhage and hypertensive encephalopathy. It is believed that hypertension initiates this syndrome. Since the episodes often occurred days, as long as 15 days, after the last unit of blood was transfused, hypertension did not seem to result from volume overload, but probably from vasopressive substances provided by or occurring in association with multiple blood-transfusions. Host factors may also contribute.