PATHOPHYSIOLOGY: Anti Leukocyte antibodies in donor blood bind to circulatory granulocytes in the recipient, and promote leukocyte sequestration in the pulmonary microvasculature. this then lead to granulocyte mediated lung injury which presents as acute respiratory distress syndrome or non cardiogenic pulm edema
CLINICAL FEATURES: Fever chills dyspnea hypoxemia, tachypnea tachycardia some times with hypotension., within a few hrs of transfusion CXR shows diffuse pulmonary infiltrates, usually resolved in a week
TREATMENT: Stop transfusion immediately, consider mechanical ventilation if picture simulates ARDS, diuretics , morphine to reduce pulm edema, physiotherapy, antibiotics. and steroids
FUTURE TRANSFUSIONS: Either by washed rbcs, or autologous transfusion
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Canadian Consensus Conference proposed criteria for transfusion-related acute lung injury (TRALI).
Criteria for TRALI
- Acute lung injury (ALI)
- Acute onset, Hypoxemia
In research setting: Ratio of PaO2/FiO2 300 or SpO2 < 90% on room air
Non-research setting: Ratio of PaO2/FiO2 300 or SpO2 < 90% on room air
Other clinical evidence of hypoxia
- Bilateral infiltrates on frontal chest radiograph
- No evidence of left atrial hypertension (i.e., circulatory overload)
- No preexisting ALI before transfusion
- During or within 6 hours of transfusion; and
- No temporal relationship to an alternative risk factor for ALI
• ALI
• No preexisting ALI before transfusion
• During or within 6 hours of transfusion; and
• A clear temporal relationship to an alternative risk factor for ALI
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2 comments:
THANK YOU VERY MUCH FOR THIS INFORMATION. IF WASHED RBCS ARE NOT AVAILABLE AND AUTOLOGOUS TRANSFUSION IS NOT PRACTISED, THEN WHAT SHOULD BE USED FOR TRANSFUSION?
Because TRALI is usually caused by WBC antibodies in the plasma of donor unit, washed RBCs or autologous RBCs are not indicated. There are very few case reports of multiple TRALI reactions in patient. If the reaction is thought to be due to the patient's WBC antibodies reacting to the WBCs in the donor unit, then it may be reasonable to consider the use of leukocyte reduced, washed, or autologous blood components for future transfusions. Diuretics should not be used for the treatment of TRALI as this may cause further hypotension. The use of Steroids is also not indicated.
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