An association between decreased cardiopulmonary complications (transfusion-related acute lung injury and transfusion-associated circulatory overload) and implementation of universal leukoreduction of blood transfusions.
An association between decreased cardiopulmonary complications (transfusion-related acute lung injury and transfusion-associated circulatory overload) and implementation of universal leukoreduction of blood transfusions.
复制标题
DOI：
10.1111/j.1537-2995.2010.02748.x
复制
发表时间：
2010-12
期刊：
影响因子：
2.9
通讯作者：
Fialkow LB
中科院分区：
文献类型：
--
作者：
Blumberg N;Heal JM;Gettings KF;Phipps RP;Masel D;Refaai MA;Kirkley SA;Fialkow LB
输血后的心脏不良事件包括急性肺损伤（TRALI）和循环超负荷（TACO），这些事件可能致命且尚未完全了解。为了确定TRALI和TACO的发生率是否受到白细胞减少的影响，我们对2000年引入普遍白细胞减少前后7年的急性输血反应进行了回顾性研究，涉及778，559种血液成分。TRALI发生率大幅下降（-83%;从普遍减白前的每10万个成分2.8例到普遍减白后的每10万个成分0.48例; p=0.01），TACO（-49%;每10万个成分7.4至3.8例; p=0.03）和发热反应（-35%;每10万个成分11.4至7.4例; p<0.0001）。过敏反应的发生率保持不变（普遍减白细胞前后为7.0/100，000）。这些结果主要归因于与RBC和血小板输注相关的TRALI/TACO降低（−64%），与FFP或冷沉淀输注相关的降低幅度明显较小（−29%）。28，120次洗涤红细胞和69，325次血小板输注后TRALI/TACO的发生率为零。这些数据为动物模型、前瞻性临床试验和新的美国血液警戒系统的进一步测试提出了新的假设：（1）TACO或TRALI是否可通过白细胞减少来缓解？(2)TACO的机制是否比血容量过多更复杂？(3)洗涤是否减轻了血小板和RBC输注引起的TRALI和TACO？
Cardiopulmonary adverse events after transfusion include acute lung injury (TRALI) and circulatory overload (TACO), which are potentially lethal and incompletely understood. To determine whether the incidence of TRALI and TACO was affected by leukoreduction we conducted a retrospective, before and after study of acute transfusion reactions for the seven years prior to and after introduction of universal leukoreduction in 2000, involving 778,559 blood components. Substantial decreases occurred in the rates of TRALI (−83%; from 2.8 cases per 100,000 components pre- to 0.48 post-universal leukoreduction; p=0.01), TACO (−49%; 7.4 to 3.8 cases per 100,000; p=0.03) and febrile reactions (−35%; 11.4 to 7.4 cases per 10,000; p<0.0001). The incidence of allergic reactions remained unchanged (7.0 per 100,000 pre- and post-universal leukoreduction). These outcomes were primarily attributable to decreased TRALI/TACO associated with RBC and platelet transfusions (−64%) with notably smaller decreases associated with FFP or cryoprecipitate transfusions (−29%). The incidence of TRALI/TACO after 28,120 washed red cell and 69,325 platelet transfusions was zero. These data suggest novel hypotheses for further testing in animal models, in prospective clinical trials, and via the new US Hemovigilance System : (1) Is TACO or TRALI mitigated by leukoreduction? (2) Is the mechanism of TACO more complex than excessive blood volume? (3) Does washing mitigate TRALI and TACO due to platelet and RBC transfusions?
登录
查看更多内容
影响因子：
20.3
作者：
Khan, Samina Yasmin;Kelher, Marguerite R.;Silliman, Christopher C.
通讯作者：
Silliman, Christopher C.
影响因子：
8.8
作者：
Watkins, Timothy R.;Rubenfeld, Gordon D.;Nathens, Avery B.
通讯作者：
Nathens, Avery B.
影响因子：
2.9
作者：
Paglino, JC;Pomper, GJ;Snyder, EL
通讯作者：
Snyder, EL
影响因子：
1.5
作者：
Eder, Anne F.;Benjamin, Richard J.
通讯作者：
Benjamin, Richard J.
影响因子：
1.9
作者：
Popovsky, Mark A.
通讯作者：
Popovsky, Mark A.