The Incidence of Transfusion-Related Acute Lung Injury at a Large, Urban Tertiary Medical Center: A Decade’s Experience

Meyer, David; Reynolds, Jacob W; Hobbs, Rhonda; Bai, Yu; Hartwell, Beth; Pommerening, Matthew J.; Fox, Erin E.; Wade, Charles E.; Holcomb, John B.; Cotton, Bryan A.

doi:10.1213/ane.0000000000003392

Cited by 21 publications

(17 citation statements)

References 19 publications

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“…[33][34][35] Fortunately, with improvements in transfusion practices and blood bank strategies (e.g., male-predominant plasma), clinically meaningful rates of TRALI remain low. 36 Despite this, higher plasma volumes have also been associated with increased rates of infection and multiorgan failure. 30 While this study was not specifically designed to assess the incidence of plasmarelated complications, it is possible that their occurrence may have been associated with worse outcomes in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Higher intraoperative plasma transfusion volumes are associated with inferior perioperative outcomes

et al. 2018

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Background: Intraoperative plasma transfusion is common, yet little is known regarding its effects on perioperative coagulation tests or clinical outcomes. Study Design and Methods: This is a retrospective cohort study of adults receiving intraoperative plasma transfusion at a single center from 2011–2015. Relationships between plasma transfusion volume, changes in coagulation test values, and clinical outcomes, including a primary outcome of early postoperative RBC transfusion, were assessed with multivariable regression analyses. Secondary outcomes included hospital mortality, ICU and hospital free days, intraoperative RBC transfusions, and estimated blood loss. Results: 3,393 unique patients were included, with median (IQR) transfusion of 2 (2, 4) units. In multivariable analyses, higher plasma volumes were associated with worse outcomes, with each 1 ml/kg increase associated with increased odds for postoperative [1.02 (1.01, 1.03); p<.001] and intraoperative RBCs [1.17 (1.16, 1.19); p<.001], and fewer ICU and hospital free days [mean difference (95% CI) −0.08 (−0.12, −0.05); p < 0.001 and −0.09 (−0.13, −0.06); p < 0.001, respectively]. Greater decreases in INR following plasma transfusion were associated with decreased odds of postoperative RBCs [0.35 (0.25, 0.47); p<.001], decreased mortality [0.50 (0.31, 0.83); p=0.007], and increased mean ICU [1.31 (0.41, 2.21); p=0.004] and hospital free days [1.15 (0.19, 2.10); p=0.018]. Conclusion: In patients receiving intraoperative plasma transfusion, higher transfusion volumes were associated with inferior clinical outcomes; however, greater improvements in INR were associated with improved outcomes. Future prospective studies are necessary to better define these relationships and to explore plasma transfusion triggers beyond the limitations of INR.

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Section: Discussionmentioning

confidence: 99%

Higher intraoperative plasma transfusion volumes are associated with inferior perioperative outcomes

et al. 2018

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“…Little dose of FFP is not efficient to completely correct TIC, whilst larger amounts generate a dilutional effect of blood cells, which then needs further transfusion of packed red blood cells. 21,38 The effectiveness of VETs guidance in resuscitation has been recognized for decades in the area of cardiothoracic surgery and organ transplantation. Regarding massive trauma, only retrospective observational studies have been published so far, except for that of Gonzalez et al 30 There is a rather long history on VETs use on clinical practice, which commenced early after the pioneering work of Hellmut Hartert, in 1948, who described the hemostatic potential of whole blood samples using TEG.…”

Section: Discussionmentioning

confidence: 99%

Trauma-induced coagulopathy. A narrative review of goal-directed hemostatic resuscitation

Pigna¹,

Lippi

Saronni

et al. 2018

Emerg Care J

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Post-traumatic haemorrhage is the leading cause of death in trauma patients. The development of coagulopathy substantially contributes to bleeding severity and to the ensuing unfavourable outcome. Trauma-induced coagulopathy (TIC) can be seen in 10-25% of patients with major trauma, and its early and appropriate therapeutic management leads to considerable reduction of mortality risk. Due to the extreme complexity of TIC pathophysiology, the limitations of conventional coagulation tests (CCTs) have become evident in recent years. Unlike these routine tests, point of care viscoelastic tests (VET) such as thromboelastogram (TEG) or rotational thromboelastography (ROTEM) provide valuable clinical information by real time assessment of changes in viscoelastic properties of blood throughout clot formation. This review was aimed to collect and discuss available evidence on goal-directed hemostatic resuscitation, based on TEG or ROTEM data. We included studies with patients aged 18 years or older, major trauma, and needing massive transfusions. Overall, 6 studies totalling 1533 patients were finally included. A total number of 288 patients died, 98 of whom in the TEG- or ROTEM-guided cohorts (i.e., intervention groups). A 36% reduction of death was observed in the intervention groups (relative risk, 0.641; 95% CI 0.517-0.795; P<0.001). Our results show that VET-guided management is effective to reduce mortality compared to conventional management with CCTs. Except for mortality, all others endpoints were heterogeneous across the studies. This emphasize the need of scheduling new and well-designed trials, aimed to better define the optimal strategy for TIC management.

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“…Utilizing only male donors or females without a pregnancy history to mitigate transfusion‐related acute lung injury (TRALI) has been successful. While important, the small risk of TRALI is outweighed by the much larger risk of dying from hemorrhagic shock if blood is not available 40,41 . When the emergency WBB plan is instituted, the Medical Director could waive this restriction if low‐TRALI‐risk donors are not available. …”

Section: Recommendationsmentioning

confidence: 99%

Civilian walking blood bank emergency preparedness plan

et al. 2021

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Background The current global pandemic has created unprecedented challenges in the blood supply network. Given the recent shortages, there must be a civilian plan for massively bleeding patients when there are no blood products on the shelf. Recognizing that the time to death in bleeding patients is less than 2 h, timely resupply from unaffected locations is not possible. One solution is to transfuse emergency untested whole blood (EUWB), similar to the extensive military experience fine‐tuned over the last 19 years. While this concept is anathema in current civilian transfusion practice, it seems prudent to have a vetted plan in place. Methods and Materials During the early stages of the 2020 global pandemic, a multidisciplinary and international group of clinicians with broad experience in transfusion medicine communicated routinely. The result is a planning document that provides both background information and a high‐level guide on how to emergently deliver EUWB for patients who would otherwise die of hemorrhage. Results and Conclusions Similar plans have been utilized in remote locations, both on the battlefield and in civilian practice. The proposed recommendations are designed to provide high‐level guidance for experienced blood bankers, transfusion experts, clinicians, and health authorities. Like with all emergency preparedness, it is always better to have a well‐thought‐out and trained plan in place, rather than trying to develop a hasty plan in the midst of a disaster. We need to prevent the potential for empty shelves and bleeding patients dying for lack of blood.

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The Incidence of Transfusion-Related Acute Lung Injury at a Large, Urban Tertiary Medical Center: A Decade’s Experience

Abstract: This study demonstrates that while TRALI still occurs, clinically meaningful cases are rare. Moreover, TRALI rates remain low despite the increasingly aggressive use of plasma and platelets in the trauma setting.

Cited by 21 publications

References 19 publications

Higher intraoperative plasma transfusion volumes are associated with inferior perioperative outcomes

Higher intraoperative plasma transfusion volumes are associated with inferior perioperative outcomes

Trauma-induced coagulopathy. A narrative review of goal-directed hemostatic resuscitation

Civilian walking blood bank emergency preparedness plan

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