Transfusion-related acute lung injury

Anaphylactic/anaphylactoid reactions, transfusion-related acute lung injury (TRALI), hemolysis, platelet destruction, and fever... 

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-... 

Kopko PM, Marshall CS, MacKenzie MR, Holland PV, Popovsky MA. Transfusion-related acute lung injury report of a clinical look-back investigation. JAMA 2002 287(15) 1968-71. 

Popovsky MA, Chaplin HC Jr, Moore SB. Transfusion-related acute lung injury a neglected, serious complication of hemotherapy. Transfusion 1992 32(6) 589-92. 

Flesch BK, Neppert J. Transfusion-related acute lung injury caused by human leucocyte antigen class II antibody. Br J Haematol 2002 II6(3) 673-6. 

The incidence of transfusion-related acute lung injury is 0.16-0.24% per transfusion of blood products and is the cause of 15% of all fatal complications of blood transfusion (11). Specific antigen-antibody reactions involving donor antibodies specific for leukocyte antigens of the recipients cause activation of neutrophils and aggregation in small pulmonary vessels (11). The complement and cytokine cascade is activated, leading to capillary leakage. 

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 ]. 

Dunbar N, Cooke M, Diab M, Toy P. Transfusion-related acute lung injury after transfusion of maternal blood a case-control study. Spine (Phila Pa 1976) 2010 ... 

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 ]. 

Respiratory Transfusion-related acute lung injury (TRALI) occurred 5 hours after treatment with intravenous anti-D immunoglobulin in a 14-year-old girl with idiopathic... 

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. 

Berger-Achituv S, Ellis MH, Curtis BR, Wolach B. Transfusion-related acute lung injury following intravenous anti-D administration in an adolescent. Am J Hematol 2008 83(8) 676-8. 

Transfusion-related acute lung injury (TRALI) is a chnical syndrome characterized by bilateral pulmonary edema in association with transfusions of blood products. It has been reported following the infusion of allogeneic hematopoietic stem cells during BMT (30,31). 

Noji H, Shichishima T, Ogawa K, et al. Transfusion-related acute lung injury following allogeneic bone marrow transplantation in a patient with acute lymphoblastic leukemia. Intern Med 2004 43(11) 1068-1072. 

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. 

Gupta V, Gupta P, Yadav TP. Transfusion related acute lung injury with intravenous immunoglobulin. Indian Pediatr October 2011 48(10) 807-8. 

---