Plasma lung injury

There are a number of biological markers measured in plasma or in bronchoalveolar lavage fluid that can be used for the detection of acute lung injury (21). To determine the extent of lung injury which occurs in septic rabbits we measured three proteins in BAL fluid collected from rabbits. 

Transfusion-related acute lung injury is an infrequent but life-threatening complication, clinically indistinguishable from adult respiratory distress syndrome (ARDS). It can occur after the administration of whole blood, erythrocytes, fresh frozen plasma, or cryoprecipitate, all of which contain variable amounts of plasma. In transfusion-related acute lung injury the symptoms of ARDS (dyspnea, pulmonary edema, severe hypoxia, fever, and hypotension) occur within 1-6 hours from the start of transfusion and usually subside within 1-4 days (44). These symptoms can vary from mild to severe and they lead to death in 5-10% of cases. The reaction may be more frequent than reported because confounding factors can mask the symptoms (45). 

The FDA has issued a Dear Colleague letter, outlining the risk of transfusion-related acute lung injury with the use of blood products, particularly those that contain plasma (48). The agency has noted that since the first report of fatal transfusion-related acute lung injury in 1992, 45 more reports have been received by the Center for Biologies Evaluation and Research. Transfusion-... 

In animal and in vitro studies, inhaled nitric oxide has led to surfactant inactivation and promotion of oxidative and nitrosylative lung injury (2). These effects have not been reported during clinical use of inhaled nitric oxide at concentrations less than 80 ppm. In a review of two articles it was noted that nitric oxide does not increase the risk of chronic lung disease of the newborn, despite speculation that it may increase chronic lung disease of prematurity due to the formation of nitrogen dioxide and peroxynitrite, in addition to membrane lipid peroxidation and increased unbound plasma iron in preterm infants (7). 

In a 58-year-old man transfusion of a unit fresh frozen plasma resulted in acute lung injury, caused by antibodies of the donor specific for the neutrophil antigen NBl (11). 

Leger R, Palm S, Wulf H, Vosberg A, Neppert J. Transfusion-related lung injury with leukopenic reaction caused by fresh frozen plasma containing anti-NBl. Anesthesiology 1999 91(5) 1529-32. 

A recent report by Parsons et a/." presented evidence for simultaneous elevation of complement fragments and measurable levels of endotoxin in plasma from patients with ARDS. Because complement activation by toxins and by other mechanisms" is thought to cause neutrophil and platelet activation" and subsequent generation of toxic oxygen species and eico-sanoids various strategies known to activate intravascular complement have been used to examine the role of eicosanoids in lung injury . To... 

Air embolism in unanaesthetized sheep causes increased permeability, lung oedema associated with oxidant stress ° and increase in thromboxane and prostacyclin in lung lymph and plasma Whereas superoxide dismutase and heparin prevented the increase in lung vascular permeability OKY-046, a thromboxane synthetase inhibitor, did not Therefore, it is conceivable that superoxide anion released from activated neutrophils is causative in this form of lung injury . 

Meaningful interpretation of eicosanoid levels in plasma or pulmonary oedema fluid during clinical sepsis or ARDS is complicated by the large number of uncontrolled variables compared with experimental sepsis or models of acute lung injury. These include diverse etiological factors precipitating sepsis and ARDS, variation in the stage of severity of these inflammatory conditions... 

Rubin, D. P., Wiener-Kronish, J. P., Murray, J. F., Green, D. R., Turner, J., Luce, J. M., Montgomery, A. B., Marks, J. D., and Matthay, M. A. (1990) Elevated von Willebrand factor antigen is an early plasma predictor of acute lung injury in nonpulmonary sepsis syndrome. J. Clin. Invest. 86, 474—480. 

The use of fresh frozen plasma (FTP) is associated with allergy, anaphylaxis, pulmonary morbidity, and transfusion-related acute lung injury (TRALI see also under blood transfusion in this chapter) [6 ,11 , 12, 29 30 31 32 33 ]. 

Adverse events related to transfusion of blood components have been reported, including febrile non-hemolytic transfusion reactions, mild febrile reactions, acute and delayed hemolytic transfusion reactions, transfusion-related acute lung injury (TRALl), anaphylactic and other allergic reactions, graft-versus-host disease (GvHD), transfusion-associated circulatory overload (TACO), viral infections, post-transfusion bacteremia, transfusion-associated sepsis (TAS), hemosiderosis, post-transfusion purpura, and new allo-antibody formation [18 , 19 ]. Whole blood, erythrocytes, leukocytes, platelets, and plasma for transfusion (fresh frozen plasma, FFP) are involved. Quite a number of these adverse effects, such as TRALl, TACO, TAS, and allergic/anaphylactic reactions can be difficult to evaluate. 

Respiratory Transfusion-related acute lung injury (TRALI) can be a serious adverse event after transfusion of plasma that contains antibodies against the recipient s leukocytes, and is the most common cause of transfusion-related mortahty. About 90% of cases of TRALI are associated with human leukocyte antigen (HLA) antibodies from the donor [39, 40 ]. Two mechanisms of TRALI have been suggested (1) an antigen-antibody reaction leads to a series of events (2) neutrophils are primed and become activated [7 ]. 

Mateen FJ, Gastineau D. Transfusion related acute lung injury (TRALI) after plasma exchange in myasthenic crisis. Neurocrit Care 2008 8(2) 280-2. 

Laga A, Kurtis J, Sweeney J. Recurrent transfusion-related acute lung injury after fresh frozen plasma in a patient with hereditary factor V deficiency. Am J Hematol 2008 83(8) 680. 

Observational studies Plasma use in paediatric hospitals between 2002 and 2009 were retrospectively analysed [38 ]. Authors identified 24 reported cases of transfusion-related acute lung injury (TRALl) among 92,731 admissions in which plasma was given. In addition, authors show that as the number of days receiving plasma increased from one to six or more, so did the rate of venous and arterial thrombosis. 

Disseminated intravascular coagulation (DlC) and hypokalaemia (before intravenous fluid therapy) have both been associated with blast lung injury. Conventional therapy including fresh frozen plasma... 

State of deviation of plasma pH (systemic acidosis) or tissue extracellular pH (tissue or local acidosis) from normal (ca. pH 7.4) towards lower values. Deviation of 0.1 pH units is significant. Systemic acidosis can be caused by lung or kidney failure. Local acidosis can be the consequence of injury, inflammation, or tumor growth, due to disruption of blood supply. Local acidosis is normally associated with hypoxia. 

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