Recurrent transfusion‐related acute lung injury after a two‐year interval

Abstract

Transfusion-related acute lung injury (TRALI) is a life-threatening complication of blood transfusion. The epidemiology and pathogenesis of TRALI are not well established. A Medline literature search shows only rare reports of recurrent TRALI, all occurring soon after the first episodes. We report a case of recurrent TRALI after a 2-year interval. A patient developed TRALI after transfusion of 4 units of fresh frozen plasma for gastrointestinal bleeding due to oesophageal varices in September 2002. The patient required mechanical ventilation but recovered completely. Two years later, in October 2004, the patient experienced a second episode of TRALI during liver transplantation for hepatitis C virus /alcoholic cirrhosis. Again, the patient recovered after ventilator support. Laboratory investigation of the first TRALI episode (2002) showed antibodies against class II human leukocyte antigens (HLA) in three female donors. Laboratory investigation of the second episode (2004) showed anti-DR52 (HLA class II) antibodies in one female donor matching the DR-52 HLA class II antigen in the recipient. TRALI can rarely recur. Consideration of future blood needs for patients experiencing recurrent TRALI should include preventive measures against further TRALI reactions, such as blood from male donors or blood less than 14 days old.

A case of recurrent transfusion‐related acute lung injury despite lessons learned from antibody mitigation

“…Although the incidence of TRALI risk per blood product is low (historically in the 10 −3 range; now in the 10 −4 to 10 −5 range), the statistical odds of its recurrence are even lower (Mulder et al ., ; Andreu et al ., ). As such, observations of recurrent TRALI may be particularly informative on specific risk factors and mechanisms of injury, be they antibody and/or non‐antibody mediated with moderate‐ to high‐risk products (Win et al ., ; Krochmal et al ., ). Recommendations from previous reports of recurrent TRALI included the provision of the lowest‐risk products (male‐only donors, fresh ≤14‐day‐old blood) (Win et al ., ; Krochmal et al ., ).…”

“…As such, observations of recurrent TRALI may be particularly informative on specific risk factors and mechanisms of injury, be they antibody and/or non‐antibody mediated with moderate‐ to high‐risk products (Win et al ., ; Krochmal et al ., ). Recommendations from previous reports of recurrent TRALI included the provision of the lowest‐risk products (male‐only donors, fresh ≤14‐day‐old blood) (Win et al ., ; Krochmal et al ., ). In our case, despite transfusions of ostensibly “low‐risk” components [i.e.…”

A quantitative model to predict blood use in adult orthotopic liver transplantation

“…Some centers achieved avoidance of RBC transfusion in up to 40% of liver recipients [4][5][6][7], and bloodless OLT has been reported in single cases and case series [8][9][10][11][12][13][14][15][16]. Also contributing to this trend is the increasing awareness of the hazards associated with blood transfusion in OLT [4,17,18], which have been observed in patients receiving red blood cells, platelets and plasma products [17,19,20]. Even a moderate number of blood components has been associated with longer hospitalization and shortened survival [4].…”

Transfusion-related acute lung injury: A dangerous and underdiagnosed noncardiogenic pulmonary edema

“…TRALI recurrence is accidental or results from higher predisposition of the recipient. While TRALI incidence is estimated at 1:5000 transfusions, the risk of 2 episodes in the same patient with no associated risk factors is statistically 1:25 million [48]. Nevertheless, some authors postulate preventive measures for patients with TRALI history and recommend to use only fresh, leukoreduced, washed red blood cell and platelet concentrates stored for less than 2 days.…”

“…Nevertheless, some authors postulate preventive measures for patients with TRALI history and recommend to use only fresh, leukoreduced, washed red blood cell and platelet concentrates stored for less than 2 days. Such measures will contribute to effective reduction of TRALI risk, regardless of pathogenesis [48,49].…”