ABSTRACT
Acute lung injury is a common adverse effect of massive blood transfusion, responsible for 17% of the deaths due to transfusion in France. A cardiac origin is often suspected. We report a case of post-transfusional pulmonary oedema in a cirrhotic patient, which could be related to a non-cardiac and underdiagnosed aetiology: the so-called transfusion related acute lung injury (TRALI).
Subject(s)
Lung Diseases/etiology , Transfusion Reaction , Acute Disease , Aged , HLA Antigens/immunology , Hepatitis B, Chronic/complications , Humans , Liver Cirrhosis/complications , Male , Pulmonary Edema/etiology , Resuscitation , Tomography, X-Ray ComputedABSTRACT
In a retrospective study, 2,238 mycologic samples obtained in 1999 from 89 patients hospitalised in an intensive care unit dedicated to digestive diseases were analysed. Feasibility of monitoring fungal colonisation and implications for workload and costs were assessed. From this experience, we confirmed the ability of the Pittet index to identify patients at high risk for Candida infection. Monitoring of Pittet index required a high degree of cooperation between the intensive care unit and the laboratory of mycology, and a precise definition of the modalities of sampling. It entailed a significant increase in costs and workload. A treatment was started whenever a colonisation index > or = 0.5 was associated with severe clinical or biological signs. This involved an increase of the expense of antifungal drugs. The potential benefits could not be evaluated from our study. Direct observation of pseudomycelium in the samples and candiduria were significantly correlated to fungal colonisation.
