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ISSN 2448-8909 (Print)

2008, Number 4

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Med Crit 2008; 22 (4)

Acute lung injury secondary to transfusion

Carrillo ER, Carrillo CLD

Language: Spanish
References: 43
Page: 241-247
PDF size: 68.17 Kb.


ABSTRACT

TRALI (Transfusion Related Acute Lung Injury) is characterized by acute respiratory distress and non-cardiogenic lung oedema developing during, or within 6 hours of transfusion. TRALI presents as a spectrum of transfusion reactions that range from mild respiratory impairment to severe fulminant and fatal pulmonary injury. Cases of TRALI reported to blood banks may represent just the tip of an iceberg, and transfusion may play an important role in more cases of ALI (Acute Lung Injury) than currently realized. TRALI must be carefully differentiated from transfusion-associated circulatory overload. In its fulminant presentation, TRALI can be clinically indistinguishable from acute respiratory distress syndrome occurring as a result of other causes. The severity of TRALI depends upon susceptibility of the patient to develop a more clinically significant reaction as a result of an underlying disease process, and upon the nature of triggers in the transfused blood components, including granulocyte-priming substances such as biologically active lipids (non-immune TRALI). Immune TRALI, which occurs mainly after the transfusion of fresh-frozen plasma and platelet concentrates, is a rare event (about one incidence per 5,000 transfusions) but frequently requires mechanical ventilation and is not uncommonly fatal. Non-immune TRALI, which occurs mainly after the transfusion of stored platelet and erythrocyte concentrates is characterized by a more benign clinical course. The main strategy in combating TRALI is prevention both through manipulation of the donor pool and through clinical strategies directed at reducing transfusion of blood products including, but not limited to, evidence based lower transfusion thresholds.


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