Study on transfusion-related acute lung injury caused by HLA-Ⅱ antibody / 中国输血杂志

【Objective】 To explore the risk factors of transfusion-related acute lung injury (TRALI). 【Methods】 The clinical symptoms, signs, imaging examinations, and laboratory test results of two patients with TRALI after blood transfusion were retrospectively analyzed, and human leukocyte antigen (HLA) genotyping of the patient and HLA antibodies typing of the plasma donors were performed. 【Results】 The clinical manifestations and laboratory parameters of two patients were consistent with those of TRALI after blood transfusion. After timely clinical respiratory support treatment, all patients were improved. Blood donors produced high titers of HLA-Ⅱ antibodies after pregnancy, including antibodies that specifically recognize the patient′s HLA antigen. 【Conclusion】 Two patients developed TRALI after platelet transfusion from a female blood donor, which was caused by HLA-Ⅱ antibodies.

Lesión Pulmonar Aguda Relacionada a Transfusión (TRALI) y dos diagnósticos diferenciales para tener en cuenta: Reporte de caso y revisión de la literatura / Transfusion-Related Acute Lung Injury (TRALI) and Two Differential Diagnoses to Consider: Case Report and Literature Review

Resumen Las complicaciones pulmonares asociadas a la transfusión de hemoderivados son reacciones adversas graves y potencialmente mor tales. La Lesión Pulmonar Aguda Relacionada a Transfusión (TRALI), es una de las más frecuentes y con mayor mortalidad asociada. Es una entidad infradiagnosticada debido a su sintomatología inespecífica, a la ausencia de biomarcadores séricos específicos para su diagnóstico y a que aún la evidencia acerca de sus causas es heterogénea. El objetivo del presente artículo es documentar un caso clínico de TRALI y posteriormente, basados en la literatura actual, consolidar los aspectos fundamentales para la identificación oportuna de esta entidad y de dos diagnósticos diferenciales en el contexto de transfusión de hemoderivados y trauma: la Sobrecarga Circulatoria Asociada a Transfusión (TACO) y el Embolismo graso (EG). Así pues, se expone el caso clínico de una paciente adulto joven quien en el contexto de un politraumatismo requiere transfusión de hemoderivados, desarrollo de cuadro clínico compatible con TRALI; de esta manera, la discusión incluye aspectos epidemiológicos, fisiopatología, hallazgos imagenológicos y diagnóstico. Se logra concluir que es preciso poner a disposición de los profesionales del área de la salud literatura científica que favorezca la identificación de estas patologías con base en criterios clínicos, paraclínicos e imagenológicos, para así mismo, disminuir el riesgo de presentación y la mortalidad asociada.

Abstract Pulmonary complications associated with the transfusion of blood products are severe, potentially mortal adverse reactions. The transfusion-related acute lung injury (TRALI) is one of the most common and with higher associated mortality. It is an underdiagnosed entity due to its unspecified symptoms, the absence of diagnosis-specific serum biomarkers and the fact that the evidence about its causes is still heterogeneous. The objective of this article is to document a clinical case of TRALI and then, basing on the current literature, consolidate key aspects for the timely identification of this disease and of two differential diagnoses within the context of transfusion of blood products and trauma: the transfusion-associated circulatory overload (TACO) and fat embolism (FE). So, we pres ent the clinical case of a female young adult patient requiring a transfusion of blood products due to a polytraumatism whose clinical condition is compatible with TRALI; thus, the discussion includes epidemiological aspects, physiopathology, imaging findings and diagnosis. We conclude that it is necessary to provide healthcare professionals with scientific literature that favors the identification of these diseases basing on clinical, paraclinical and imaging criteria so as to reduce the risk of presentation and associated mortality.

TRALI as a Cause of Massive Tracheal Secretions during Cardiac Surgery / 日本心臓血管外科学会雑誌

A 46 year-old man underwent double valve replacement for valve insufficiency due to infective endocarditis. Upon withdrawal from extracorporeal circulation and administration of 8 units of fresh frozen plasma, a large amount of yellow serous secretion was aspirated from the trachea, and rapid and exacerbated oxygenation was observed. We determined that the patient was not congested, based on his hemodynamics; instead, he appeared to have acquired transfusion-related acute lung injury (TRALI). The patient was given a steroid infusion. By the time the patient returned to the intensive care unit, his oxygenation capacity improved and the secretions from his trachea decreased. The patient was weaned off the ventilator on the second post-operative day. Inhaled nitric oxide was very effective in improving oxygenation. We conjectured that TRALI should be recognized as a differential diagnosis for poor oxygenation after withdrawal from extracorporeal circulation.

Tirofiban interferes with antibody-mediated transfusion-related acute lung injury by inhibiting platelet-neutrophil binding / 中国输血杂志

【Objective】 To explore the feasibility of tirofiban, a platelet surface glycoprotein (GP)Ⅱb/Ⅲa receptor antagonist intervene in transfusion-related acute lung injury (TRALI), by inhibiting platelet activation and by preventing platelet and neutrophil binding to form aggregates. 【Methods】 1) Fifty wild-type male Balb/c mice, aged 8 to 10 weeks, were randomly divided into TRALI, normal, tirofiban TRALI intervention, isotype control and tirofiban normal intervention groups. In the TRALI model, tirofiban TRALI intervention and isotype control groups, each mouse was injected intraperitoneally with lipopolysaccharide (LPS) 0.1 mg/kg, and after 18 h with 4.5 mg/kg anti-MHC-I or IgG2a isotype control antibody, in which 0.5 μg/g tirofiban was injected 30 min before anti-MHC-I injection, and was labeled as tirofiban TRALI intervention. The group without any treatment was set as normal group. The tirofiban normal intervention group was injected with only 0.5 μg/g tirofiban into the tail vein, 30 min before the injection of anti-MHC-I. 2) After antibody injection, the mice were observed for 2 h, then executed with their lungs removed, and the extent of lung injury and the intervention effect of tirofiban were analyzed by comparing the differences in lung dry to wet ratio, total protein, myeloperoxidase (MPO), inflammatory factors and quantitative results of HE staining. The platelet activation level in whole blood and immunofluorescence (IF) quantification of platelet and neutrophil fluorescence were detected by flow cytometry to analyze the mechanism of tirofiban on TRALI. 【Results】 1) The indexes of lung injury in the tirofiban TRALI intervention group and TRALI model group for HE staining were 0.663 3±0.141 9 vs. 0.173 3±0.120 4 (P<0.05), respectively; 2) Platelet activation levels(%)in whole blood in the TRALI group, normal group and tirofiban TRALI intervention group were 22.87±9.943 vs 5.070±2.234 vs 5.767±3.224(P<0.05), respectively. 3) The mean fluorescence density of platelet neutrophil aggregates for IF detection in the tirofiban intervention group and TRALI model group was 21.89±3.536 vs. 32.77±0.9624 (P<0.05). 【Conclusion】 The platelet GP Ⅱ b/Ⅲa-specific inhibitor tirofiban inhibited platelet-neutrophil binding in mice, thus could possibly intervene in TRALI.

Study on the protective effect of rapamycin-treated dendritic cells on transfusion-related acute lung injury after infection / 中国输血杂志

【Objective】 To investigate the viability of rapamycin-treated rapamycin-treated dendritic cells (DCs) in intervening transfusion-related acute lung injury (TRALI) after infection. 【Methods】 1)The TRALI mouse model was induced by lipopolysaccharide (LPS) combined with anti-H2Kd antibody. The mice anal temperature and the wet/dry ratio of lung, kidney, spleen and brain tissues were measured. 2) Mouse bone marrow-derived DC cells were induced in vitro and treated with rapamycin (10nM) for 24h. 3) Mice were injected with or without rapamycin or rapamycin-treated DC, then injected with LPS intraperitoneally one hour later, finally injected with anti-H2Kd antibody 24 hours later to induce the onset of TRALI. The death situation of the mice was observed and recorded. The condition of mice after the onset of TRALI was analyzed by mouse body temperature, lung wet-dry ratio, and pleural effusion weight and lung histopathological sections. 【Results】 By comparing the induction effects of anti-H2Kd antibody solutions with different concentrations and volumes, the mouse model induced by 0.1mg/kg LPS combined with 4.5 mg/kg anti-H2Kd antibody (infusion volume of 100μL) was selected as the TRALI mouse model for this study. After the onset of TRALI, the wet/dry ratio of the lungs could be significantly increased and the body temperature could be significantly reduced in the model mice. After the intervention of TRALI mice with DCs treated with rapamycin, the mortality rate was significantly reduced, and the lung tissue lesions of the mice were significantly improved, whose protection effect was better than that of the rapamycin-treated group. Compared with the TRALI incidence group, the weight of pleural effusion in the intervention group was significantly reduced (P<0.05), but there was no significant difference in lung wet/dry ratio and body temperature. 【Conclusion】 The combination of LPS and antibodies can effectively induce a stable and typical TRALI mouse model, suggesting that the presence of infectious inflammation and blood transfusion-related inflammatory substances are the decisive factor for the pathogenesis of TRALI. Meanwhile, DCs treated with rapamycin have a protective effect on post-infection transfusion-related acute lung injury, which is expected to be a potential cell therapy strategy to intervene in the exacerbation of TRALI.

Activation of death receptor 3 signaling pathway prevents antibody-mediated transfusion-related acute lung injury via αDR3 antibody / 中国输血杂志

【Objective】 To explore the efficacy and possible mechanisms of activation of Death receptor 3 (DR3) signaling pathway in the prevention of antibody-mediated transfusion-related acute lung injury (TRALI) via DR3 agonistic (αDR3) antibody. 【Methods】 8-10-week-old male wild-type Balb/c mice (40) were randomly divided into Naïve group, isotype control group, TRALI model group, and intervention group. Mice without any treatment served as Naïve group. Isotype and TRALI model were established by intraperitoneally priming 8-10-week Balb/c mice with LPS 18 h prior to injection of an IgG2a isotype antibody and anti-MHC-Ⅰ antibody via tail vein, respectively. Intervention group: mice were intraperitoneally injected with a single dose of αDR3 antibody (1 mg/kg) on day 1; after 3 days, the mice were challenged with LPS 18 h prior to injection of an anti-MHC-I antibody. The lung tissues and spleens of mice in each group were collected at the mice died or 2 hours after TRALI modeling for the lung injury severity. Spleens were collected to measure the proportion of Treg by flow cytometry. Foxp3, iNOS, and CD206 immunohistochemical staining combining with optical density analysis of lung tissues were used to represent Treg, M1 macrophages and M2 macrophages, respectively. The concentration of IL-6, IL-1β, TNF-α, and IL-10 cytokines in lung tissues was detected via Cytometric Beads Array. 【Results】 Compared with TRALI group, 1) the lung injury of mice were significantly alleviated in intervention group; 2) the proportion of Treg(%) in the spleens (9.295±1.349 vs 2.257±0.610, P<0.05), Foxp3 expression of Treg in the lungs (0.302 6±0.052 6 vs 0.230 2±0.016 3, P<0.05), and the concentration of Treg derived cytokines IL-10 in the lungs (29.52±8.885 vs 8.045±1.911, P<0.05) increased significantly in intervention group; 3) the iNOS expression of M1 macrophages (0.209 6±0.013 9 vs 0.279 6±0.045 2) and the concentration of M1 macrophage derived cytokines IL-6 (23.22±19.35 vs 301.1±157.7), IL-1β (46.76±25.34 vs 307.6±183.8), and TNF-α (45.99±14.16 vs 143.9±44.43) in the lungs was significantly reduced(P<0.05), while CD206 expression of M2 macrophages (0.291 2±0.032 1 vs 0.221 5±0.012 7) and the concentration of M2 macrophage derived IL-10 cytokines (29.52±8.885 vs 8.045±1.911) in the lungs increased significantly in intervention group(P<0.05). 【Conclusion】 Activation of DR3 signaling pathway by αDR3 antibody prevents antibody-mediated TRALI via expanding Treg, which regulates macrophage polarization by IL-10 derived from Treg.

Potential of modulating fibrinolytic activity in intervention of transfusion-related acute lung injury / 中国输血杂志

Transfusion-related acute lung injury (TRALI), with clinical manifestation, diagnosis and pathological mechanism consistent with acute lung injury(ALI), belongs to a sub-category of ALI. Excessive deposition of fibrin in lung is one of the characteristic of ALI, and reversing fibrin formation is of great significance to intervene ALI. The decrease of fibrinolytic activity is one of the important causes of excessive deposition of fibrin in lung, and also the important pathological feature of TRALI. This article discusses the potential of modulating fibrinolytic activity to intervene TRALI from the perspective of regulating the effectiveness of fibrinolytic activity to intervene ALI.

Function of platelet-derived extracellular vesicles in adverse reactions to blood transfusion / 中国输血杂志

Recent studies have shown that a series of structural and functional changes would occur during the process of platelet collection, storage and transfusion. The storage of platelets would induce the production of extracellular vesicles. During the process of platelet transfusion, extracellular vesicles play a critical role by carrying diverse substances under various pathophysiological conditions, which causes adverse reactions to blood transfusion. Ceramide and soluble CD40L (sCD40L) carried by platelet-derived extracellular vesicles may lead to transfusion-related acute lung injury (TRALI). Extracellular vesicles containing mtDNA are considered as damage-associated molecular patterns (DAMPs), which can mediate local and systemic inflammation and promote inflammation through interactions with leukocytes and monocytes. Platelet derived extracellular vesicles contain lots of procoagulant substances, which are considered as prethrombotic substances. The RNA of varying species or content carried by vesicles during the process of platelet storage may also related to the occurrence of adverse reactions to blood transfusion.

TRALI, una amenaza enmascarada: biología y fisiopatología / TRALI, a masked menace: biology and pathophysiology

El daño pulmonar agudo ocasionado por la transfusión o TRALI (por sus siglas en inglés), definido como la aparición de un distrés respiratorio agudo en un paciente recién transfundido, pasó de ser considerado una complicación infrecuente de la terapia transfusional a ser actualmente la principal causa de mortalidad por transfusión, según sistemas de hemovigilancia de Europa y Norteamérica. Su desarrollo en forma clínicamente reconocible se atribuye a la interacción entre factores dependientes de la unidad transfundida (tipo de componente, presencia de sustancias biológicamente activas, etc.) y el estado de las respuestas celulares en el receptor. La heterogeneidad en cuanto al cuadro clínico de los pacientes afectados,la variación en el volumen infundido, el tipo de componente implicado y el tiempo desde el inicio de la transfusión hasta la aparición de los síntomas, ha hecho evolucionar la explicación a la génesis de este evento adverso, en el afán de incluir los casos sin explicación mediante las distintas hipótesis. Dos interesantes acercamientos patogénicos resultan la teoría de dos golpes y el modelo basado en el umbral que impone la relación entre los distintos factores de riesgo. La naturaleza multicausal del TRALI y el sinnúmero de variables que pueden influir en su aparición y reconocimiento, continúan haciendo de este un reto médico importante en el contexto de la medicina transfusional, donde su mejor enfoque terapéutico sigue siendo el preventivo(AU)

Transfusion-related acute lung injury (TRALI) defined as the onset of an acute respiratory distress in a recently transfused patient, has passed from been considered a rare complication of transfusion therapy to be the leading cause of transfusion-associated death, as reported by hemovigilance systems in Europe and America. In a previous paper definition, epidemiology and some clinical aspects of TRALI are reviewed. Now we focused our efforts in reviewing the incompletely understood world of its pathogenesis. Clinically recognizable TRALI´s development depends on the interaction between risk factors from both the transfused component unit (as the kind of component and substances within it) and receiver patient´s cellular response. Heterogeneity of clinical features, transfused volumes, component type and time elapsed from the beginning of transfusion to the onset of symptoms have pushed the explanations for its genesis to evolve in an effort to include as much cases as the different hypotheses allowed. Two interesting approaches to TRALI´s pathogenesis are the two hit; theory and the threshold; model imposed by risk factors interactions. The large diversity of variables and causes which can influence its onset and clinical recognition continue to make it a real challenge for clinicians, mainly within transfusion medicine, where the best therapeutic approach available is prevention(AU)

Trali, una amenaza enmascarada: definición, aspectos epidemiológicos y clínicos / Trali, a masked threat: definition, epidemiological and clinical aspects

El daño pulmonar agudo relacionado con la transfusión o TRALI, como más comúnmente se le conoce, por definición no se diferencia de otros tipos de distrés respiratorios, salvo por su origen demostrable y su estrecha relación temporal con la transfusión. Constituye una de las reacciones adversas más peligrosas del uso de productos sanguíneos y sus peculiares características le permiten enmascararse entre los muchos factores que pueden desencadenar un daño pulmonar agudo, especialmente en algunos pacientes que resultan más susceptibles a su desarrollo. El propósito de esta revisión es hacer un recordatorio de su existencia, sobre todo a aquellos médicos que manejan cotidianamente pacientes demandantes de componentes sanguíneos y cuya condición clínica favorece su aparición. Sus principales variables epidemiológicas (ej: incidencia y mortalidad) varían, a veces de manera notable, entre los distintos informes. La heterogeneidad de criterios aun después de la consecución de consensos internacionales para su diagnóstico, dificulta aprovechar al máximo los datos obtenidos de los distintos estudios realizados sobre su comportamiento y ha promovido la aparición de no pocos resultados contradictorios. Su diagnóstico clínico representa un reto al presentarse en medio de contextos clínicos que hacen plantear otras causas para la aparición del distrés respiratorio. Por ello, muchas veces pasa inadvertido o es mal identificado(AU)

Transfusion-related acute lung injury better known as TRALI, has not differences with other kinds of acute respiratory distress, except for its close relation with transfusion. It is considered among the greatest hazards on blood products use. With its peculiar characteristics it mimics within the many factors that may trigger an acute respiratory distress, especially among those patients at high risk for suffering lung damage after transfusion. The main purpose of this review is to make a recall of the existence of TRALI for those physicians who deal with high transfusion-demanding patients or those with conditions which could represent a risk for its development. TRALI´s main epidemiological variables (such as incidence and mortality) show important variations among different investigations. The criteria heterogeneity, even after the consecution of international diagnostic consensus, has made it difficult to take advantage of the data arose from multiple studies about its behavior, promoting the report of not a few contradictory results on worldwide publications. Diagnosing TRALI represents a real challenge for the clinician since it often appears within the context of various possible causes for an acute respiratory distress. This is why TRALI is frequently overlooked or misdiagnosed(AU)

A Case Report of Transfusion-Related Acute Lung Injury Induced in the Patient with HLA Antibody after Fresh Frozen Plasma Transfusion / 대한수혈학회지

Development of transfusion-related acute lung injury (TRALI), a non-cardiogenic pulmonary edema, after blood transfusion, is a rare but potentially leading cause of mortality from blood transfusion. We report on a case of TRALI in a 51-year male with acute calculous cholecystitis and liver cirrhosis. As preoperative treatment, he was given ten units of fresh frozen plasma (FFP) for 3 days before the operation. During the transfusion of the 10th unit of FFP, he experienced a sudden onset of hemoptysis, tachypnea, tachycardia, and cyanosis. Bilateral pulmonary infiltration not observed on the chest X-ray at the visit was newly developed. There was no evidence of volume overload but severe hypoxemia. Blood transfusion was stopped and he recovered fully after 8 days of oxygen therapy through a nasal cannula. Although HLA and HNA antibodies were not detected in the donor's blood, HLA antibodies (A2, B57, B58) were detected in the patient's blood. We reported this meaningful case of TRALI that occurred after transfusion of only fresh frozen plasma which did not contain human leukocyte antibody in a patient with HLA antibody.

Human Neutrophil Alloantigen-3a Alloimmunization among Pregnant Korean Women / 대한수혈학회지

BACKGROUND: Alloantibodies against human neutrophil alloantigen (HNA)-3a are associated with severe and fatal transfusion related acute lung injury (TRALI). HNA-3 genotyping and HNA-3a antibody (Ab) identification are essential to diagnosis and prevention of TRALI caused by HNA-3a Ab. However there had been no laboratory for HNA-3a Ab identification in Korea. The aims of this study were to establish the HNA-3a Ab test in Korea and to estimate the incidence of HNA-3a alloimmunization among pregnant Korean women. METHODS: HNA-3a homozygotes and HNA-3b homozygotes were identified by HNA-3 genotyping. Three HNA-3a homozygotes and three HNA-3b homozygotes are included in the granulocytes panel, which consisted of 10 donors for granulocytes. Sera from 650 pregnant Korean women were tested for granulocyte Ab using a mixed passive hemagglutination assay (MPHA). When a HNA-3a Ab was detected, the woman's HNA-3 was typed to support her HNA-3a alloimmunization. RESULTS: MPHA showed positive reactions in the sera from 26 women (4.0%, 26/650). HLA Abs were detected in 18 women (2.8%, 18/650), among whom HNA Abs were identified simultaneously in 7 women. Granulocyte Abs were detected in sera from 15 women (2.3%, 15/650). The incidence of HNA-3a, HNA-1b, HNA-1a, HNA-2a, and unidentified HNA Abs among pregnant Korean women was 0.77% (5/650), 0.77% (5/650), 0.62% (4/650), 0.15 (1/650), and 0.31% (2/650), respectively. CONCLUSION: In this study, we established the HNA-3a Ab test using MPHA for diagnosis and prevention of TRALI caused by HNA-3a Ab. The incidence of HNA-3a Ab in pregnant Korean women was 0.77% (5/650).

Daño pulmonar agudo asociada a transfusión en el embarazo / Acute Lung Damage Associated with Transfusion during Pregnancy

Introducción: el daño pulmonar agudo asociado a la transfusión es una reacción adversa a la transfusión poco frecuente, la mortalidad se ha estimado entre 1-10 %. Su diagnóstico es clínico e infrecuentemente sospechado, su incidencia es baja. Presentación del caso: se presentaron dos transfusión-related-acute-lunginjury en dos gestantes con 28,5 y 32 semanas de embarazo respectivamente, hospitalizadas en la salas de cuidados materno perinatales con enfermedades asociadas al embarazo, a quienes se le administraron componentes sanguíneos, ambas a las 5 horas de transfundidas; presentaron el síndrome clínico con hipoxemia moderada y necesitaron ventilación; con estos hallazgos y la relación temporal con la transfusión. Se realizó el diagnóstico de síndrome de dificultad respiratoria aguda moderada asociada a transfusión. Conclusiones: el resultado fue óptimo con resolución completa del evento respiratorio. Se considera importante reportar ambos casos dado su aparición en embarazadas, causa poco frecuente informada en la literatura y la importancia de conservar la salud de la madre del niño y la niña e incentivar la notificación de esta reacción adversa a la transfusión al banco de sangre para fortalecer el sistema de hemovigilancia.

Introduction: acute lung damage associated with transfusion is a little frequent adverse effect to transfusion; mortality has been estimated between 1-10%. Its diagnosis is clinical and infrequently suspected about. Its incidence is low even so. Case report: but two cases presented, hospitalized in the maternal-perinatal care room, with diseases associated to pregnancy, and they were administered blood components, both five hours after the transfusion, presented a clinical syndrome with moderate hypoxemia, and needed ventilation; with this findings and the temporal relation with transfusion, we diagnosed moderate acute transfusion-associated respiratory difficulty syndrome. Conclusions: The result was the best, with full resolution if the respiratory event. It is important to report both cases due to their onset in pregnant women, a less frequent cause informed about in the medical texts, and the importance of preserving the mother´s and the child´s health, and promote the notification of this adverse reaction to transfusion to the blood bank, in order to strengthen the hemosurveillance system.

A case of transfusion-related acute lung injury induced by anti-human leukocyte antigen antibodies in acute leukemia

Transfusion-related acute lung injury (TRALI) is a noncardiogenic pulmonary edema that occurs during or within 6 hours after transfusion. Risk factors for TRALI, which is relatively common in critically ill patients, include recent surgery, hematologic malignancy, and sepsis. Here, we report a case of TRALI induced by anti-human leukocyte antigen (anti-HLA) class II antibodies (HLA-DR) occurring after transfusion of platelet concentrates in a patient with acute leukemia. Although most patients with TRALI show improvement within 48-96 hours, our patient's condition rapidly worsened, and he did not respond to supportive treatment. TRALI is a relatively common and serious adverse transfusion reaction that requires prompt diagnosis and management.

"Possible TRALI" developed during bilateral total knee arthroplasty replacement: A case report / 대한마취과학회지

Transfusion-related acute lung injury (TRALI) is one of the leading causes of transfusion-related morbidity and mortality. However, it is frequently not diagnosed and under-reported, which could result in inappropriate treatment. Diagnostic definition for TRALI consists of hypoxia and bilateral pulmonary edema occurring during or within 6 hours of a transfusion in the absence of cardiac failure or intravascular volume overload. Here, we report a fatal case, which resulted from under-recognition and misdiagnosis of TRALI occurring during transfusion with packed red blood cells during a bilateral total knee replacement.

Diagnosis of Transfusion-Related Acute Lung Injury (TRALI) in a Heart Failure Patient / 대한수혈학회지

A 71-yr old man with known coronary heart disease complained of dyspnea and severe sweating one hour after transfusion of one unit of packed Red Blood Cells (pRBC). Although the heart failure was secondary to the remote acute myocardial infarction, except inflammatory lesion in his toes, he had remained asymptomatic for a long time. Observed as having clear lungs a few hours before transfusion, the patient suffered an acute hypoxic episode (SpO2=61%) and a resulting chest x-ray revealed bilateral pulmonary infiltrates. Confused as the cause of the acute deterioration, he was transferred to the intensive care unit and received managed lung care by mechanical ventilation as well as other conservative care methods. Two days after the acute hypoxic event there was apparent clinical improvement, and he was weaned from ventilator support. His amelioration resulted in subsequent diagnosis of Transfusion-Related Acute Lung Injury (TRALI). TRALI is underdiagnosed in patients due to its nebulous nature. Evaluating patients exhibiting symptoms of bilateral lung infiltrate after blood transfusion for TRALI, and subsequent reporting of the diagnosis results, will help reveal the actual frequency of incidence of TRALI, and prevent additional events by tracing the blood donor.

Two Cases of Transfusion-related Acute Lung Injury Triggered by HLA and Anti-HLA Antibody Reaction

Transfusion-related acute lung injury (TRALI) is a serious adverse transfusion reaction that is presented as acute hypoxemia and non-cardiogenic pulmonary edema, which develops during or within 6 hr of transfusion. Major pathogenesis of TRALI is known to be related with anti-HLA class I, anti-HLA class II, or anti-HNA in donor's plasma. However, anti-HLA or anti-HNA in recipient against transfused donor's leukocyte antigens also cause TRALI in minor pathogenesis and which comprises about 10% of TRALI. Published reports of TRALI are relatively rare in Korea. In our cases, both patients presented with dyspnea and hypoxemia during transfusion of packed red blood cells and showed findings of bilateral pulmonary infiltrations at chest radiography. Findings of patients' anti-HLA antibodies and recipients' HLA concordance indicate that minor pathogenesis may be not as infrequent as we'd expected before. In addition, second case showed that anti-HLA class II antibodies could be responsible for immunopathogenic mechanisms, alone.

Transfusion-Related Acute Lung Injury (TRALI) in Patients with Aneurysmal Subarachnoid Hemorrhage (SAH) / 대한뇌혈관외과학회지

OBJECTIVE: Transfusion-related acute lung injury (TRALI) is a poorly understood, but life-threatening complication after transfusion of blood components. The present study was conducted to identify the incidence of TRALI in patients with aneurysmal subarachnoid hemorrhage (SAH) as well as to determine the risk factors for TRALI. METHODS: This retrospective study was carried out on our institute, during the period of Jan. 2006 and Dec. 2008 to a total of 237 patients who underwent microsurgical treatment for aneurysmal SAH. In this time period, 154 patients were finally enrolled in this study. Patients' demographics, clinical and radiographic factors relevant to the aneurysms and SAH, and parameters regarding transfusion were analyzed and compared. RESULTS: A total of 9 patients had TRALI among a total of 154 patients. The incidence of TRALI was 0.01% (9 in 836) for all transfused blood component, and 0.06% (9 in 154) for all transfused patients. Statistical analysis showed that Fisher grade III and IV (OR, 1.88; 95% CI, 1.13-3.07) and total amount of transfused units exceeding 1,200cc (OR 1.72; 95% CI, 1.22-2.65) were associated with the development of TRALI. On the other hand, sex, poor Hunt-Hess Grade (IV and V), preoperative hemoglobin less than 13, postoperative hemoglobin less than 11, use of volume expander, premorbid disease (hypertension, diabetes) were not associated with TRALI. CONCLUSIONS: The results of present study indicate that large amount SAH and transfusion of blood components more than 1,200cc are risk factors for the development of TRALI. Prospectively designed study with a larger cohort is mandated to confirm the etiology and risk factors of TRALI in stroke practice.

Transfusion related acute lung injury occurred in HLA half-matched hematopoietic stem cell transplantation:a case report and literature review / 中国输血杂志

Objective To clarify the risk,treatment and preventive measurement of transfusion related acute lung injury (TRALI) occurred in HLA half-matched hematopoietic stem cell transplantation. Methods A case of TRALI occurred in HLA half-matched hematopoietic stem cell transplantation was analyzed,including the clinical characteristics,the laboratory and instrumental examination,the treatment measure and prognosis,and then the associated literature was reviewed.Results Owing to the blood products(fresh platelet) transfusion during transplantation,the patient got TRALI. And after active rescue,the patient eventually died due to the worsen condition.Conclusion The risk of TRALI is very high in HLA half-matched hematopoietic stem cell transplantation since the blood products transfusion is inevitable,so the effective and timely treatment and preventive measurement are necessary.

Two Cases of Transfusion Related Acute Lung Injury / 결핵및호흡기질환

Transfusion related acute lung injury (TRALI) is a serious, potentially life-threatening complication of transfusion therapy that is sometimes under diagnosed and under reported. Patients with TRALI present with dyspnea/respiratory distress and fever. The symptoms, signs and chest radiological findings in TRALI are similar to transfusion associated circulatory overload, which makes it is difficult to distinguish it from circulatory overload. Although the mortality rate in cases of TRALI is relatively low, TRALI is the third most common cause of fatal transfusion reactions next to ABO blood type incompatibility and hepatitis. Mild-to-moderate cases of TRALI may be misdiagnosed as volume overload. Recently, we encountered two cases where the patients suffered from dyspnea and fever after a transfusion. and review of the relevant literature.