TRALI • LITFL • CCC Airway

Transfusion related acute lung injury (TRALI) is defined as hypoxia and bilateral pulmonary edema occurring during or within 6 h of a transfusion in the ... Skiptocontent Blog ECGlibrary CCC Eponyms PartONE Top100 Podcasts FullMenu Instagram Facebook Twitter OVERVIEW Transfusionrelatedacutelunginjury(TRALI)isdefinedashypoxiaandbilateralpulmonaryedemaoccurringduringorwithin6hofatransfusionintheabsenceofothercausessuchascardiacfailureorintravascularvolumeoverload incidenceis1in5,000Uofplasmacontainingproducts(FFP,plateletsorwholeblood) CAUSE Theories donoranti-granulocyticantibodiescalledleukoagglutininsinplasmatargetrecipientleucocyteantigensonneutrophilssequesteredinthelungs,resultinginanimmunereaction“biologicalresponsemodifiers”(BRMs)suchascytokinesandbiologicallyactivelipids(e.g.inagedcellularcomponents)causealung-mediatedresponse Pathophysiology “2hit”model:lungcapillariesareprimedbyanunderlyingillness thentriggeredbyexposuretoirritantinbloodtransfusion Step1:underlyingillness->complementactivation->pulmonarysequestrationofneutrophilsStep2:transfusion->neutrophilactivation->endothelialcelldamageandcapillaryleaksyndrome CLINICALFEATURES dyspneahypoxiafeverhypotensionorhypertension DIAGNOSIS acuteonsetALI(within6hoursofatransfusionhypoxia(PaO2/FiO2<=300mmHgregardlessofPEEPorSpO2)bilateralpulmonaryinfiltratesnotcardiogenicinorigin(PAWP<18mmHg) DIFFERENTIALDIAGNOSIS acutepulmonaryoedemae.g.TACO(transfusionassociatedcirculatoryoverload),LVF,negativepressurepulmonaryedema,neurogenicaspirationpneumonitisinhalationalinjuryALI/ARDSduetosepsisorothercausesfatembolismdiffusealveolarhaemorrhage(expecthemoptysis) INVESTIGATIONS haemoconcentrationhypoalbuminaemianeutropeniaorneutrophiliapulmonaryfluidanalysis(hydrostaticversuscapillaryleak) MANAGEMENT stoptransfusionrespiratorysupport(mayrequireNIVorintubation)lungprotectiveventilationifintubatedhaemodynamicsupportifneedede.g.noradrenalinesupportivecareandmonitoringnoevidenceforsteroidsinformbloodbankandhaematology PROGNOSIS mostrecoverwithin48-96hoursradiologicalchangesoftenlast7daysmortality5% PREVENTION limittransfusionofbloodproductspreoperativeoptimizationofbloodvolume(dietarysupplements,Fe2+,EPO),preventhypothermia,useantifibrinolytics,cellsalvageavoiddonations(especiallyFFP)frommultiparouswomen ReferencesandLinks GajicO,GropperMA,HubmayrRD.Pulmonaryedemaaftertransfusion:howtodifferentiatetransfusion-associatedcirculatoryoverloadfromtransfusion-relatedacutelunginjury.CritCareMed.2006May;34(5Suppl):S109-13.PMID:16617253.SayahDM,LooneyMR,ToyP.Transfusionreactions:newerconceptsonthepathophysiology,incidence,treatment,andpreventionoftransfusion-relatedacutelunginjury.CritCareClin.2012Jul;28(3):363-72PMC3380279.ShazBH,StowellSR,HillyerCD.Transfusion-relatedacutelunginjury:frombedsidetobenchandback.Blood.2011Feb3;117(5):1463-71.PMID:20944069.TriulziDJ.Transfusion-relatedacutelunginjury:currentconceptsfortheclinician.AnesthAnalg.2009Mar;108(3):770-6.PMID:19224781. CriticalCareCompendium…moreCCC ChrisNickson ChrisisanIntensivistandECMOspecialistatthe AlfredICUinMelbourne.HeisalsoaClinicalAdjunctAssociateProfessoratMonashUniversity. Heisaco-founderofthe AustraliaandNewZealandClinicianEducatorNetwork (ANZCEN)andistheLeadforthe ANZCENClinicianEducatorIncubator programme.HeisontheBoardofDirectorsforthe IntensiveCareFoundation andisaFirstPartExaminerforthe CollegeofIntensiveCareMedicine.HeisaninternationallyrecognisedClinicianEducatorwithapassionforhelpingclinicianslearnandforimprovingtheclinicalperformanceofindividualsandcollectives. AfterfinishinghismedicaldegreeattheUniversityofAuckland,hecontinuedpost-graduatetraininginNewZealandaswellasAustralia’sNorthernTerritory,PerthandMelbourne.Hehascompletedfellowshiptraininginbothintensivecaremedicineandemergencymedicine,aswellaspost-graduatetraininginbiochemistry,clinicaltoxicology,clinicalepidemiology,andhealthprofessionaleducation. HeisactivelyinvolvedininusingtranslationalsimulationtoimprovepatientcareandthedesignofprocessesandsystemsatAlfredHealth.HecoordinatestheAlfredICU’seducationandsimulationprogrammesandrunstheunit’seducation website, INTENSIVE. Hecreatedthe‘CriticallyIllAirway’courseandteachesonnumerouscoursesaroundtheworld.Heisoneofthefoundersofthe FOAM movement(FreeOpen-AccessMedicaleducation)andisco-creatorof litfl.com, the RAGEpodcast,the Resuscitology course,andthe SMACC conference. Hisonegreatachievementisbeingthefatherofthreeamazingchildren. On Twitter,heis @precordialthump. |INTENSIVE|RAGE|Resuscitology|SMACC Related LeaveaReplyCancelreply ThissiteusesAkismettoreducespam.Learnhowyourcommentdataisprocessed. 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