Use of B‐natriuretic peptide as a diagnostic marker in the differential diagnosis of transfusion‐associated circulatory overload

Zhou, Lan; Giacherio, Donald; Cooling, Laura; Davenport, Robertson D.

doi:10.1111/j.1537-2995.2005.04326.x

Cited by 124 publications

(93 citation statements)

References 28 publications

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“…Two case reports demonstrated the possible utility of BNP to distinguish TRALI from TACO [51,52]. Zhou et al [53] demonstrated that a 0.5 increase in BNP following transfusion has a sensitivity of 81% and a specificity of 89% for the diagnosis of TACO; however, in this study, the authors were not able to compare their data to BNP levels in patients with TRALI. A variant of BNP, N-terminal pro-brain natriuretic peptide (NT-proBNP), has a longer half-life in circulation and is also more stable in laboratory samples.…”

Section: Differential Diagnosiscontrasting

confidence: 52%

Pulmonary Transfusion Reactions

Bux

Sachs

2008

Transfus Med Hemother

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Background: In recent years, pulmonary transfusion reactions have gained increasing importance as serious adverse transfusion events. Methods: Review of the literature. Results: Pulmonary transfusion reactions are not extremely rare and, according to hemovigilance data, important causes of transfusion-induced major morbidity and death. They can be classified as primary with predominant pulmonary injury and secondary as part of another transfusion reaction. Primary reactions include transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO) and transfusion-associated dyspnea (TAD). Secondary pulmonary reactions are often observed in the wake of hemolytic transfusion reactions, hypotensive/anaphylactic reactions, and transfusion-transmitted bacterial infections. Conclusion: Knowledge and careful management of cases of pulmonary transfusion reactions are essential for correct reporting to blood services and hemovigilance systems. Careful differentiation between TRALI and TACO is important for taking adequate preventive measures.

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Section: Differential Diagnosiscontrasting

confidence: 52%

Pulmonary Transfusion Reactions

Bux

Sachs

2008

Transfus Med Hemother

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“…B-natriuretic peptide (BNP) may have some value in distinguishing transfusionassociated circulatory overload from TRALI. 5 Circulatory overload is suggested by an absolute BNP level greater than 100 pg/dL and a posttransfusion-to-pretransfusion ratio greater than 1.5. 5 In contrast to ARDS from other causes, patients typically recover with resolution of pulmonary infiltrates within 96 hours.…”

Section: Clinical and Laboratory Diagnosismentioning

confidence: 99%

Transfusion-Related Acute Lung Injury: An Update

Triulzi

2006

Hematology

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Transfusion-associated acute lung injury (TRALI) has emerged as a leading cause of transfusion-related morbidity and mortality. TRALI is characterized by acute non-cardiogenic pulmonary edema and respiratory compromise in the setting of transfusion. The study of TRALI has been hampered by inadequate case definitions and an incomplete understanding of the pathologic mechanisms. Recent consensus conferences took an important first step by providing a framework for case definition. Recent advances in the understanding of the pathogenesis of TRALI have also occurred. TRALI has been primarily attributed to donor leukocyte antibodies that are thought to interact with recipient neutrophils, resulting in activation and aggregation in pulmonary capillaries, release of local biologic response modifiers causing capillary leak, and lung injury. An alternate mechanism termed the "two hit" or "neutrophil priming" hypothesis postulates that a pathway to neutrophil activation and aggregation can occur without leukocyte antibodies. A first event such as sepsis or trauma can induce pulmonary endothelial activation, release of cytokines, and priming of neutrophils. A subsequent second event such as exposure to lipids, cytokines or antibodies in a blood component would then cause activation of adherent neutrophils and a release of bioreactive molecules leading to lung injury. There are limited clinical and animal studies to support the "two hit" model. These proposed mechanisms are not mutually exclusive in that donor leukocyte antibody can be pathogenic in both models and have implications for new strategies to prevent TRALI.Advances in blood safety have greatly reduced the risk of transfusion-associated infectious disease transmission. As a result, noninfectious serious hazards of transfusion have come to the forefront as increasingly important blood safety issues. Transfusion-associated acute lung injury (TRALI) has emerged as a leading cause of transfusion related morbidity and mortality.1 This report will summarize recent consensus conferences that have provided practical clinical definitions of TRALI to aid the clinician in diagnosis and to facilitate its study. Recent advances in understanding of the pathogenesis of TRALI will be presented with a potential unifying hypothesis. DefinitionA lack of a standardized definition of TRALI has hindered accurate clinical diagnosis, epidemiology, and research investigation. A recent NHLBI working group convened to identify research needs addressed this critical issue by providing the following definition: "new acute lung injury (ALI) occurring during or within 6 hours after a transfusion, with a clear temporal relationship to transfusion, in patients without or with risk factors for ALI other than transfusion."2 Limitations to the proposed NHLBI working group definition are the exclusion of patients with preexisting ALI, excluding cases with onset more than 6 hours after transfusion, lack of laboratory diagnostic criteria, and a required severity of hypoxia that would miss cases of mil...

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“…The ECHO evaluation of the patient was shown that the left ventricule diameter was 4.9 cm, EF was 70% and no other heart wall motion defects was denoted also. Though it has been reported that B-type Natriuretic Peptide (BNP) has some value in distinguishing TACO from TRALI, (16) Zhou et al demonstrated 81% sensitivity, 89% specificity, 89% positive and 81% negative predictive value and 87% accuraccy of BNP (B type natriuretic peptide) in diagnosing TACO (16). In any case, we could not measure the level of this hormone in our hospital at that time.…”

Section: Discussionmentioning

confidence: 84%