Transfusion-related acute lung injury - Wikipedia

Transfusion-related acute lung injury (TRALI) is the serious complication of transfusion of blood products that is characterized by the rapid onset of excess ... Transfusion-relatedacutelunginjury FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch Thisarticleneedsadditionalcitationsforverification.Pleasehelpimprovethisarticlebyaddingcitationstoreliablesources.Unsourcedmaterialmaybechallengedandremoved.Findsources: "Transfusion-relatedacutelunginjury" – news ·newspapers ·books ·scholar ·JSTOR(January2017)(Learnhowandwhentoremovethistemplatemessage) MedicalconditionTransfusion-relatedacutelunginjuryOthernamesTRALIMicrographofdiffusealveolardamage,thehistologiccorrelateofTRALI;H&EstainSpecialtyPulmonology Transfusion-relatedacutelunginjury(TRALI)istheseriouscomplicationoftransfusionofbloodproductsthatischaracterizedbytherapidonsetofexcessfluidinthelungs.[1]Itcancausedangerousdropsinthesupplyofoxygentobodytissues.AlthoughchangesintransfusionpracticeshavereducedtheincidenceofTRALI,itwastheleadingcauseoftransfusion-relateddeathsintheUnitedStatesfromfiscalyear2008throughfiscalyear2012.[2] Contents 1Signsandsymptoms 2Cause 3Pathophysiology 4Diagnosis 5Treatment 6Epidemiology 7Seealso 8References 9Externallinks Signsandsymptoms[edit] ItisoftenimpossibletodistinguishTRALIfromacuterespiratorydistresssyndrome(ARDS).ThetypicalpresentationofTRALIisthesuddendevelopmentofshortnessofbreath,severehypoxemia(O2saturation<90%inroomair),lowbloodpressure,andfeverthatdevelopwithin6hoursaftertransfusionandusuallyresolvewithsupportivecarewithin48to96hours.AlthoughlowbloodpressureisconsideredoneoftheimportantsignsfordiagnosingTRALI,insomecaseshighbloodpressurecanoccur.[3] DelayedTRALIoccurs6to72hoursaftertransfusioncompletion.Itisassociatedwithahigherrateofmortality.[4] Cause[edit] ThecauseofTRALIiscurrentlynotfullyunderstood.80–85%ofcasesarethoughttobeimmunemediated.[5][6][7]Antibodiesdirectedtowardhumanleukocyteantigens(HLA)orhumanneutrophilantigens(HNA)havebeenimplicated.Womenwhoaremultiparous(havecarriedmorethanonepregnancytoviablegestationalage)developtheseantibodiesthroughexposuretofetalblood;transfusionofbloodcomponentsobtainedfromthesedonorsisthoughttocarryahigherriskofinducingimmune-mediatedTRALI.[7]Previoustransfusionortransplantationcanalsoleadtodonorsensitization.TobeatriskofTRALIviathismechanism,thebloodrecipientmustexpressthespecificHLAorneutrophilreceptorstowhichtheimplicateddonorhasformedantibodies.Atwo-hithypothesishasbeensuggested[8]whereinpre-existingpulmonarypathology(i.e.,thefirst-hit)leadstolocalizationofneutrophilstothepulmonarymicrovasculature.Thesecondhitoccurswhentheaforementionedantibodiesaretransfusedandattachtoandactivateneutrophils,leadingtoreleaseofcytokinesandvasoactivesubstancesthatinducenon-cardiacpulmonaryedema.[9] Anon-immunemechanismhasbeenstudiedandproposedbySilliman.Itinvolvestheaccumulationofbioactivelipidsinstoredbloodcomponents(redcells,platelets,orplasma)thatarecapableofprimingneutrophils.[3] TRALIistypicallyassociatedwithplasmaproductssuchasfreshfrozenplasma.TRALIcanalsooccurinrecipientsofpackedredbloodcells,whetheradultorpediatricpatients.[10]DuetothehigherriskofTRALIresultingfromdonationsbyfemales,theAABB(formerlytheAmericanAssociationofBloodBanks)hasrecommendedthatthosebloodcomponentswithahighvolumeofplasmanotbeusedfortransfusion,butforfurtherprocessingintoothertherapeuticproducts.[11] Pathophysiology[edit] InTRALI,first-hitriskfactorsincludelong-termexcessivealcoholuse,shock,liversurgery,currentsmoking,higherpeakairwaypressurewhileundergoingmechanicalventilation,positiveintravascularfluidbalance,lowlevelsofinterleukin-10,andsystemicinflammation.SystemicinflammationmaybereflectedintheplasmacytokineprofilesbutalsoviaincreasedlevelsofC-reactiveprotein(CRP),anacute-phaseproteinthatrapidlyincreasesduringacuteinfectionsandinflammationandiswidelyusedclinicallyasabiomarkerofinflammation.CRPhasbeenshowntobeelevatedinTRALIpatientsand,inamousemodel,tofunctionallyenablethefirsthitinthedevelopmentofTRALIbyincreasingtheaccumulationinthelungsofaneutrophilhomologoustointerleukin-8.AnotherfactorthatcanpredisposepatientstoTRALIispre-existinglunginjury,whichcauseswhitebloodcellstolocalizeinthelungs'bloodvessels.[12]ThesecondhitinTRALImaybeconveyedbyanti-leukocyteantibodiesorotherfactorspresentinthetransfusionproduct.Inapproximately80%ofcases,anti-HLAclassIorIIoranti-HNAantibodiesareimplicatedasinvolvedintriggeringTRALI,althoughthatfiguremaybeevenhigherdependingonthedetectionmethodsused.Intheremaining20%ofTRALIcases,non–antibodyfactorsorbiologicalresponsemodifiersaresuggestedtocontributethesecondhit,andthesemaypossiblyincludelipidmediators,extracellularvesicles,andagedbloodcells.[13] Diagnosis[edit] ChestX-rayoftransfusion-relatedacutelunginjury(TRALI)comparedtochestX-rayofthesamepersonaftertreatment TRALIisdefinedasanacutelunginjurythatistemporallyrelatedtoabloodtransfusion;specifically,itoccurswithinthefirstsixhoursfollowingatransfusion.[14] Itistypicallyassociatedwithplasmacomponentssuchasplateletsandfreshfrozenplasma,thoughcaseshavebeenreportedwithpackedredbloodcellssincethereissomeresidualplasmainthepackedcells.[11]Incidentshavealsobeenreportedwithotherbloodproductsincluding"cryoprecipitate,granulocytes,intravenousimmuneglobulin,allogeneicandautologousstemcells".[15] Itisadiagnosisuponexaminationofclinicalmanifestationsthatappearwithin6hoursoftransfusion,suchasacuterespiratorydistress,tachypnea,hypotension,cyanosis,anddyspnea.TRALIisanuncommonsyndrome,thatisduetothepresenceofleukocyteantibodiesintransfusedplasma.Itisbelievedtooccurinapproximatelyoneinevery5000transfusions.[3]Leukoagglutinationandpoolingofgranulocytesintherecipient'slungsmayoccur,withreleaseofthecontentsofleukocytegranules,andresultinginjurytocellularmembranes,endothelialsurfaces,andpotentiallytolungparenchyma.Inmostcasesleukoagglutinationresultsinmilddyspneaandpulmonaryinfiltrateswithinabout6hoursoftransfusion,andspontaneouslyresolves.[citationneeded] Occasionallymoreseverelunginjuryoccursasaresultofthisphenomenonandacuterespiratorydistresssyndrome(ARDS)results.LeukocytefiltersmaypreventTRALIforthosepatientswhoselunginjuryisduetoleukoagglutinationofthedonorwhitebloodcells,butbecausemostTRALIisduetodonorantibodiestoleukocytes,filtersarenothelpfulinTRALIprevention.Transfusedplasma(fromanycomponentsource)mayalsocontainantibodiesthatcross-reactwithplateletsintherecipient,producingusuallymildformsofposttransfusionpurpuraorplateletaggregationaftertransfusion.[citationneeded] Anothernonspecificformofimmunologictransfusioncomplicationismildtomoderateimmunosuppressionconsequenttotransfusion.Thiseffectoftransfusionisnotcompletelyunderstood,butappearstobemorecommonwithcellulartransfusionandmayresultinbothdesirableandundesirableeffects.Mildimmunosuppressionmaybenefitorgantransplantrecipientsandpatientswithautoimmunediseases;however,neonatesandotheralreadyimmunosuppressedhostsmaybemorevulnerabletoinfection,andcancerpatientsmaypossiblyhaveworseoutcomespostoperatively.[citationneeded] Treatment[edit] ThemainstayoftherapyinTRALIissupportivecare.OxygensupplementationisemployedinallreportedcasesofTRALI,and72%ofpatientsrequireaggressiverespiratorysupport.Tosupportbloodpressure,intravenousadministrationoffluids,aswellasvasopressors,areessential.IntreatingTRALI,diureticsaretobeavoided,althoughtheyareindicatedinthemanagementoftransfusionassociatedcirculatoryoverload.Corticosteroidscanbebeneficial.[citationneeded] Epidemiology[edit] ThetrueincidenceofTRALIisunknownbecauseofthedifficultyinmakingthediagnosisandbecauseofunderreporting.Itisestimatedtooccurin1:1300to1:5000transfusionsofplasma-containingproducts.TRALIistheleadingreportedcauseofdeathrelatedtotransfusionintheUnitedStates;morethan20caseswerereportedperyearfrom2003to2005.[citationneeded]TheimmunemediatedformofTRALIoccursapproximatelyonceevery5000transfusionsandhasamortalityof6–9%.[16] Seealso[edit] Flashpulmonaryedema References[edit] ^Gajic,Ognjen;Moore,S.Breanndan(2005)."Transfusion-RelatedAcuteLungInjury".MayoClinicProceedings.80(6):766–770.doi:10.1016/S0025-6196(11)61531-0.PMID 15945528. ^U.S.FoodandDrugAdministration,CenterforBiologicsEvaluationandResearch.FatalitiesReportedtoFDAFollowingBloodCollectionandTransfusion:AnnualSummaryforFiscalYear2012.Bethesda,Md:U.S.FoodandDrugAdministration. ^abcSilliman,C.C.;Fung,Y.L.;Ball,J.B.;Khan,S.Y.(2009)."Transfusion-relatedacutelunginjury(TRALI):CurrentConceptsandMisconceptions".BloodReviews.23(6):245–255.doi:10.1016/j.blre.2009.07.005.PMC 3134874.PMID 19699017. ^ChoMS,ModiP,SharmaS.Transfusion-relatedAcuteLungInjury.2020Jul26.In:StatPearls[Internet].TreasureIsland(FL):StatPearlsPublishing;2020Jan–.PMID 29939623 ^"Transfusion-relatedacutelunginjury(TRALI)".ProfessionalEducation. ^Dykes,A.;Smallwood,D.;Kotsimbos,T.;Street,A.(2000)."Transfusion-RelatedAcuteLungInjury(Trali)InAPatientWithASingleLungTransplant".BritishJournalofHaematology.109(3):674–6.doi:10.1046/j.1365-2141.2000.01999.x.PMID 10886228.S2CID 42922617. ^abMuller,J.Y.(2005)."LeTRALI :dudiagnosticàlaprévention"[TRALI:fromdiagnosistoprevention].TransfusionCliniqueetBiologique(inFrench).12(2):95–102.doi:10.1016/j.tracli.2005.04.007.PMID 15894508.INIST:16924693. ^Silliman,ChristopherC.(2006)."Thetwo-eventmodeloftransfusion-relatedacutelunginjury".CriticalCareMedicine.34(5Suppl):S124–131.doi:10.1097/01.CCM.0000214292.62276.8E.ISSN 0090-3493.PMID 16617256.S2CID 36068011. ^Harmening,Denise(2019).ModernBloodBanking&TransfusionPractices.Philadelphia:F.A.DavisCompany.p. 381.ISBN 9780803668881. ^Cudilo,ElizabethM.;Varughese,AnnaM.;Mahmoud,Mohamed;Carey,PatriciaM.;Subramanyam,Rajeev;Lerman,Jerrold(2015)."Casereportoftransfusion-relatedacutelunginjuryinapediatricspinesurgerypatienttransfusedleukoreducedredbloodcells".PediatricAnesthesia.25(12):1294–7.doi:10.1111/pan.12696.PMID 26126598.S2CID 5106831. ^abAssociationBulletin#14-02.TRALIRiskMitigationforPlasmaandWholeBloodforAllogeneicTransfusion.Bethesda:AABB;1/29/2014 ^KleinmanS,KorDJ.“Transfusion-relatedacutelunginjury(TRALI).”In:UpToDate,PostTW(Ed),UpToDate,Waltham,MA.Lastupdated5/11/17.Accessedviahttp://www.uptodate.com/contents/transfusion-related-acute-lung-injury-tralion6/28/17. ^Semple,JohnW.;Rebetz,Johan;Kapur,Rick(April25,2019)."Transfusion-associatedcirculatoryoverloadandtransfusion-relatedacutelunginjury".Blood.133(17):1840–1853.doi:10.1182/blood-2018-10-860809.ISSN 1528-0020.PMID 30808638. ^ToyP,PopovskyMA,AbrahamE,AmbrusoDR,HolnessLG,KopkoPM,McFarlandJG,NathensAB,SillimanCC,StroncekD(2005)."Transfusion-relatedacutelunginjury:definitionandreview".CriticalCareMedicine.33(4):721–6.doi:10.1097/01.ccm.0000159849.94750.51.PMID 15818095. ^ChoMS,ModiP,SharmaS.Transfusion-relatedAcuteLungInjury.2020Jul26.In:StatPearls[Internet].TreasureIsland(FL):StatPearlsPublishing;2020Jan–.PMID 29939623. ^Bux,J.(2005)."Transfusion-relatedacutelunginjury(TRALI):aseriousadverseeventofbloodtransfusion".VoxSanguinis.89(1):1–10.doi:10.1111/j.1423-0410.2005.00648.x.PMID 15938734.S2CID 26023653. Externallinks[edit] TransfusionRelatedAcuteLungInjury-USFoodandDrugAdministration(FDA). NeutrophilAntigensandAntibodies-AmericanSocietyofHistocompatibilityandImmunogenetics. ClassificationDICD-9-CM:518.7 vteBloodtransfusionandtransfusionmedicineBloodproducts Wholeblood Platelets Platelettransfusion Redbloodcells Plasma Freshfrozenplasma PF24 Cryoprecipitate Cryosupernatant Whitebloodcells Granulocytetransfusion Bloodsubstitutes Generalconcepts Bloodbank Blooddonation Bloodmanagement Methods Apheresis(plasmapheresis,plateletpheresis,leukapheresis) Exchangetransfusion Intraoperativebloodsalvage Tests Bloodcompatibilitytesting Cross-matching Coombstest Kleihauer–Betketest InternationalSocietyofBloodTransfusion ISBT128 Transfusionreactionsandadverseeffects Transfusionhemosiderosis Transfusionrelatedacutelunginjury Transfusionassociatedcirculatoryoverload Transfusion-associatedgraftversushostdisease Febrilenon-hemolytictransfusionreaction Hemolyticreaction acute delayed Serumsickness Transfusiontransmittedinfection Bloodgroupsystems Bloodtypes ABO Secretorstatus Augustine CD59 Chido-Rodgers Colton Cromer Diego Dombrock Duffy Er FORS Gerbich GIL GLOB Hh Ii Indian JR JMH KANNO Kell(Xk) Kidd Knops Lan Lewis Lutheran LW MNS OK P Raph RhandRHAG Scianna Sid T-Tn Vel Xg Yt Other Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Transfusion-related_acute_lung_injury&oldid=1084975849" Categories:ComplicationsofsurgicalandmedicalcareIntensivecaremedicineLungdisordersTransfusionreactionsTransfusionmedicineHiddencategories:CS1French-languagesources(fr)ArticlesneedingadditionalreferencesfromJanuary2017AllarticlesneedingadditionalreferencesArticleswithshortdescriptionShortdescriptionmatchesWikidataAllarticleswithunsourcedstatementsArticleswithunsourcedstatementsfromAugust2016 Navigationmenu Personaltools NotloggedinTalkContributionsCreateaccountLogin Namespaces ArticleTalk English Views ReadEditViewhistory More Search Navigation MainpageContentsCurrenteventsRandomarticleAboutWikipediaContactusDonate Contribute HelpLearntoeditCommunityportalRecentchangesUploadfile Tools WhatlinkshereRelatedchangesUploadfileSpecialpagesPermanentlinkPageinformationCitethispageWikidataitem Print/export DownloadasPDFPrintableversion Inotherprojects WikimediaCommons Languages العربيةDeutschFrançaisGaeilgeItalianoPolski中文 Editlinks