Severe Transfusion-Related Acute Lung Injury

Brander, Lukas; Reil, Angelika; Bux, Juergen; Taleghani, Behrouz Mansouri; Regli, Bruno; Takala, Jukka

doi:10.1213/01.ane.0000159375.26910.9c

Cited by 27 publications

(31 citation statements)

References 11 publications

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“…The mortality rate has been reported as 5 to 14% [3,4] in contrast to that of ALI/Adult Respiratory Distress Syndrome (ALI/ARDS), which is 30% and 50% (3). Due to underreporting, however, the true incidence is unknown but has been estimated to be 0.014% to 0.02% per unit transfused [3].…”

Section: Discussionmentioning

confidence: 99%

Severe transfusion-related acute lung injury managed with extracorporeal membrane oxygenation (ECMO) in an obstetric patient

Lee¹,

Koyyalamudi²,

Martinez-Ruiz³

2008

Journal of Clinical Anesthesia

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Section: Discussionmentioning

confidence: 99%

Severe transfusion-related acute lung injury managed with extracorporeal membrane oxygenation (ECMO) in an obstetric patient

Lee¹,

Koyyalamudi²,

Martinez-Ruiz³

2008

Journal of Clinical Anesthesia

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“…However, only single measurements were provided for each patient, and the timing of these measurements relative to the infusion of blood products was not reported. Brander et al 12 included a series of PA pressure measurements in their case report of a patient with TRALI, but the first measurement was not taken until two hours after the onset of hypoxemia. This showed moderate pulmonary hypertension of 33/20 mmHg, which gradually returned to normal within the next few days.…”

Section: Discussionmentioning

confidence: 99%

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

Lin

Kanani

Naughton

et al. 2007

Can J Anesth/J Can Anesth

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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.

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“…Severe metabolic derangement from massive transfusion may occur as a consequence of dilutional coagulopathy, dilutional thrombocytopenia, DIC, citrate toxicity, metabolic alkalosis, hypocalcemia, hypomagnesemia, hyperkalemia, acid/base disturbances and hypothermia [42] . Blood products transfusions have been identified as a risk factor for TRALI, ALI and ARDS [43] . ARDS is a serious multifactorial complication after OLTx most likely caused by fluid overload from crystalloid liquid infusion or massive transfusion and reperfusion syndrome [44] .…”

Section: Intraoperative Blood Transfusion Complications and Outcomementioning

confidence: 99%

Blood loss, predictors of bleeding, transfusion practice and strategies of blood cell salvaging during liver transplantation

Feltracco¹

2013

WJH

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Blood loss during liver transplantation (OLTx) is a common consequence of pre-existing abnormalities of the hemostatic system, portal hypertension with multiple collateral vessels, portal vein thrombosis, previous abdominal surgery, splenomegaly, and poor "functional" recovery of the new liver. The intrinsic coagulopathic features of end stage cirrhosis along with surgical technical difficulties make transfusion-free liver transplantation a major challenge, and, despite the improvements in understanding of intraoperative coagulation profiles and strategies to control blood loss, the requirements for blood or blood products remains high. The impact of blood transfusion has been shown to be significant and independent of other well-known predictors of posttransplant-outcome. Negative effects on immunomodulation and an increased risk of postoperative complications and mortality have been repeatedly demonstrated. Isovolemic hemodilution, the extensive utilization of thromboelastogram and the use of autotransfusion devices are among the commonly adopted procedures to limit the amount of blood transfusion. The use of intraoperative blood salvage and autologous blood transfusion should still be considered an important method to reduce the need for allogenic blood and the associated complications. In this article we report on the common preoperative and intraoperative factors contributing to blood loss, intraoperative transfusion practices, anesthesiologic and surgical strategies to prevent blood loss, and on intraoperative blood salvaging techniques and autologous blood transfusion. Even though the advances in surgical technique and anesthetic management, as well as a better understanding of the risk factors, have resulted in a steady decrease in intraoperative bleeding, most patients still bleed extensively. Blood transfusion therapy is still a critical feature during OLTx and various studies have shown a large variability in the use of blood products among different centers and even among individual anesthesiologists within the same center. Unfortunately, despite the large number of OLTx performed each year, there is still paucity of large randomized, multicentre, and controlled studies which indicate how to prevent bleeding, the transfusion needs and thresholds, and the "evidence based" perioperative strategies to reduce the amount of transfusion.

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Severe Transfusion-Related Acute Lung Injury

Cited by 27 publications

References 11 publications

Severe transfusion-related acute lung injury managed with extracorporeal membrane oxygenation (ECMO) in an obstetric patient

Severe transfusion-related acute lung injury managed with extracorporeal membrane oxygenation (ECMO) in an obstetric patient

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

Blood loss, predictors of bleeding, transfusion practice and strategies of blood cell salvaging during liver transplantation

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