Transfusion-related acute lung injury (TRALI) in an obstetric patient

Michala, Lina; Madhavan, B.; Win, Nay; Lord, C. De; Brown, Richard N

doi:10.1016/j.ijoa.2007.07.002

Cited by 10 publications

(5 citation statements)

References 16 publications

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“…Previous hemovigilance studies suggest that 6.7 to 15% of reported TRALI occur among obstetrics-gynecological patients, 19 , 20 but data so far published within in this setting are scarce or even anecdotal. 21 , 22 In our retrospective series of heavily transfused patients, we found an overall incidence of TRALI/pTRALI of 16,9%, that is noteworthy. We investigated a limited number of patients, representing a fraction of the overall population with PPH admitted to our hospital in the same period.…”

Section: Discussionmentioning

confidence: 55%

Acute Lung Injury Complicating Blood Transfusion in Post-Partum Hemorrhage: Incidence and Risk Factors.

Teofili¹,

Bianchi²,

Zanfini³

et al. 2014

Mediterr J Hematol Infect Dis

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BackgroundWe retrospectively investigated the incidence and risk factors for transfusion-related acute lung injury (TRALI) among patients transfused for post-partum hemorrhage (PPH).MethodsWe identified a series of 71 consecutive patients with PPH requiring the urgent transfusion of three or more red blood cell (RBC) units, with or without transfusion of fresh frozen plasma (FFP) and/or platelets (PLT). Clinical records were then retrieved and examined for respiratory distress events. According to the 2004 consensus definition, cases of new-onset hypoxemia, within 6 hours after transfusion, with bilateral pulmonary changes, in the absence of cardiogenic pulmonary edema were identified as TRALI. If an alternative risk factor for acute lung injury was present, possible TRALI was diagnosed.ResultsThirteen cases of TRALI and 1 case of possible TRALI were identified (overall incidence 19.7%). At univariate analysis, patients with TRALI received higher number of RBC, PLT and FFP units and had a longer postpartum hospitalization. Among the diseases occurring in pregnancy- and various pre-existing comorbidities, only gestational hypertension and pre-eclampsia, significantly increased the risk to develop TRALI (p = 0.006). At multivariate analysis including both transfusion- and patient-related risk factors, pregnancy-related, hypertensive disorders were confirmed to be the only predictors for TRALI, with an odds ratio of 27.7 ( 95% CI 1.27–604.3, p=0.034).ConclusionsPatients suffering from PPH represent a high-risk population for TRALI. The patients with gestational hypertension and pre-eclampsia, not receiving anti-hypertensive therapy, have the highest risk. Therefore, a careful monitoring of these patients after transfusions is recommended.

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Section: Discussionmentioning

confidence: 55%

Acute Lung Injury Complicating Blood Transfusion in Post-Partum Hemorrhage: Incidence and Risk Factors.

Teofili¹,

Bianchi²,

Zanfini³

et al. 2014

Mediterr J Hematol Infect Dis

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“…The few patients who had a complication in the absence of respiratory distress usually had higher body mass index (BMI) and Lung ultrasound score. Overall, LUS examinations in which a pulmonary complication was detected had higher global LUS score than negative LUS examinations (four [3][4][5][6][7][8][9] versus zero [0-1]; P < 0.001). The baseline global LUS score was different in the four patient groups, and for different pulmonary complications (Figure 3).…”

Section: Resultsmentioning

confidence: 99%

“…3 Pulmonary complications requiring transitory or intense critical care treatment may arise before, during, and even after the primary obstetric disease is resolved. Among obstetric patients in Sierra Leone, additional risk factors for developing pulmonary complications include pregnancy-associated cardiopulmonary changes, 5 iatrogenic fluid overload, tocolytic therapy, 5 transfusion-related acute lung injury in patients who receive blood transfusions, 6 and sickle cell disease. 7 Bedside imaging techniques are increasingly available to detect pulmonary pathologies, including point-of-care lung ultrasound (LUS).…”

Section: Introductionmentioning

confidence: 99%

Lung Ultrasound for Detection of Pulmonary Complications in Critically Ill Obstetric Patients in a Resource-Limited Setting

Pisani

Nicolo

Schiavone

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Critically ill parturients have an increased risk of developing pulmonary complications. Lung ultrasound (LUS) could be effective in addressing the cause of respiratory distress in resource-limited settings with high maternal mortality. We aimed to determine the frequency, timing of appearance, and type of pulmonary complications in critically ill parturients in an obstetric unit in Sierra Leone. In this prospective observational study, LUS examinations were performed on admission, after 24 and 48 hours, and in case of respiratory deterioration. Primary endpoint was the proportion of parturients with one or more pulmonary complications, stratified for the presence of respiratory distress. Secondary endpoints included timing and types of complications, and their association with “poor outcome,” defined as a composite of transfer for escalation of care or death. Of 166 patients enrolled, 35 patients (21% [95% CI: 15–28]) had one or more pulmonary complications, the majority diagnosed on admission. Acute respiratory distress syndrome (period prevalence 4%) and hydrostatic pulmonary edema (4%) were only observed in patients with respiratory distress. Pneumonia (2%), atelectasis (10%), and pleural effusion (7%) were present, irrespective of respiratory distress. When ultrasound excluded pulmonary complications, respiratory distress was related to anemia or metabolic acidosis. Pulmonary complications were associated with an increased risk of poor outcome (odds ratio: 5.0; 95% CI: 1.7–14.6; P = 0.003). In critically ill parturients in a resource-limited obstetric unit, LUS contributed to address the cause of respiratory distress by identifying or excluding pulmonary complications. These were associated with a poor outcome.

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“…Risks associated with transfusions are infections, hemolytic transfusions reactions, allergic reactions, and transfusion-related acute lung injury. 23,24 It is of high importance to reduce these risks as much as possible, most effectively by reducing transfusion requirement. 25 In cardiac surgery, there is clear evidence that a restrictive transfusion strategy reduces morbidity and mortality.…”

Section: Point-of-care Devicesmentioning

confidence: 99%

Experience of Point-of-Care Devices in Obstetrical Care

Karlsson

2017

Semin Thromb Hemost

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During pregnancy and puerperium, there are pronounced hemostatic changes characterized by increased coagulability and decreased fibrinolysis. In addition, hemostasis can change dramatically during obstetric complications. Several reports have described substandard management of hemostatic defects in this setting and state the need for guidelines and better care. Point-of-care devices can assess hemostatic status and are especially suitable in perioperative settings. Using point-of-care devices, no time is required for transportation, allowing faster availability of results and providing potential for better care of the patient. This article will demonstrate the use of a viscoelastic method in six different patients; five with impaired hemostasis, and where the use of viscoelastic method contributes or should have contributed to better care. The cases represent patients with normal delivery; postpartum hemorrhage (PPH); PPH with low fibrinogen; placental abruption; preeclampsia with hemolysis, elevated liver enzymes, low platelet count syndrome; and finally, one patient with sepsis. This article also shows the need for good practices and good supervision to implement the devices in patient care.

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Transfusion-related acute lung injury (TRALI) in an obstetric patient

Cited by 10 publications

References 16 publications

Acute Lung Injury Complicating Blood Transfusion in Post-Partum Hemorrhage: Incidence and Risk Factors.

Acute Lung Injury Complicating Blood Transfusion in Post-Partum Hemorrhage: Incidence and Risk Factors.

Lung Ultrasound for Detection of Pulmonary Complications in Critically Ill Obstetric Patients in a Resource-Limited Setting

Experience of Point-of-Care Devices in Obstetrical Care

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