Transfusion-Related Acute Lung Injury with Hemophagocytic Lymphohistiocytosis in Aplastic Anemia: Case Report / 임상소아혈액종양

ABSTRACT

Transfusion-related acute lung injury (TRALI) is a serious clinical syndrome associated with transfusion and has come to be recognized as the leading cause of transfusion-related death recently. TRALI occurs more often in critically ill patients (sepsis, surgery, massive transfusion, cytokine administration) than in a general hospital population, possibly due to the presence of underlying inflammatory conditions that may prime pulmonary neutrophils. We report a case of TRALI developed in a female aplastic anemia patient who presented with a persisting fever for several days. Serologic tests of the patient were consistent with acute EBV infection. As hemophagocytic lymphohistiocytosis developed under septic condition, bicytopenia persisted and the patient needed repeated transfusions. Following transfusion of the blood components, the patient experienced hypotension and a significant change in respiratory status within 6 hours. A chest computed tomography showed newly developed diffuse ground-glass opacities on both lungs. The finding was a non-cardiogenic effect and there was no volume overloading. Anti-neutrophil antibody was detected in serum, and the patient was diagnosed as TRALI. Recurrent lung injury with prolonged pancytopenia caused pulmonary hemorrhage. The patient was managed with mechanical ventilation prior to death.