Présentation de cas : lésion pulmonaire aiguë associée à la transfusion (TRALI) — Un danger net et présent

Abstract

Purpose: To describe a case of transfusion-related acute lung injury (TRALI) after platelet transfusion immediately following cardiac surgery, and to review the clinical features, pathophysiology, management, and morbidity and mortality associated with such an event.Clinical features: A 62-yr-old man was transferred to our centre for urgent coronary artery bypass grafting in the setting of recent anti-platelet medication use. Soon after surgery he received platelet transfusions despite having only moderate blood loss. Shortly following the platelet transfusion, he suffered acute hypoxic and hypotensive decompensation requiring nitric oxide therapy, inotropic support, and prolonged need for mechanical ventilation. The patient was eventually discharged from the intensive care unit nine days following the event. The diagnosis of TRALI was made by clinical and radiographic criteria. Conclusion:Transfusion-related acute lung injury is now the leading cause of transfusion-related fatalities. Early diagnosis of TRALI is important and these reactions should be reported to the blood transfusion service so that appropriate action can be taken to prevent future morbidity and mortality in other patients. To reduce serious transfusion reactions, inappropriate transfusions must be minimized and the decision to transfuse blood products should be taken with care.

High-Frequency Oscillatory Ventilation for Rescue From Refractory Hypoxemia in a Patient With Transfusion-Related Acute Lung Injury

“…14 For severe TRALI patients, strategies other than conventional mechanical ventilation, including prone position, nitric oxide inhalation, or extracorporeal membrane oxygenation, have been successfully applied to improve oxygenation. [15][16][17] However, there is no report of HFOV in severe TRALI patients.…”

COMMENTARY: Relative safety of pooled whole blood–derived versus single‐donor (apheresis) platelets in the United States: a systematic review of disparate risks

“…Informative in this respect are the Quebec hemovigilance data from 2001 (when PWBD PLTs were the principal PLT component transfused in the province): there were four cases of TRALI, one associated with RBCs and three with PWBD PLTs (risk of 1 per 5532 PLT pools) 6 . Reports of clinical cases of TRALI associated with PWBD PLTs continue to appear from Canada 99 where—outside Quebec—the majority of therapeutic PLT doses are provided as PWBD PLTs, as well as from US hospitals that still transfuse PWBD PLTs 100 . Silliman and coworkers 26 had previously reported on 90 cases of TRALI, only 25% of which were associated with HLA Class I or II or neutrophil antibodies in donor sera—a proportion not different from that in controls.…”

Introducing Blood Conservation Into Clinical Practice

“…10 A number of consensus panels have convened to better define transfusionrelated acute lung injury and have proposed efforts to mitigate risk 11,12 ; however, the most reasonable proposal to reduce risk is to eliminate unnecessary transfusions. 13 In the surgical setting, erythrocyte transfusion has been associated with increased postoperative complications including septicemia, bacteremia, and surgical site infections 14,15 ; pulmonary complications 16 ; cardiac and renal morbidity 17 ; and higher mortality. 15,17,18 These complications are reportedly dose dependent, but even minimal amounts of transfusion (i.e., only 1 U) have been associated with a higher morbidity risk 15 (Figure 1).…”