Transfusion-related acute lung injury: epidemiology and a prospective analysis of etiologic factors
Transfusion-related acute lung injury: epidemiology and a prospective analysis of etiologic factors
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DOI：
10.1182/blood-2002-03-0958
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发表时间：
2003-01-15
期刊：
影响因子：
20.3
通讯作者：
Ambruso, DR
中科院分区：
文献类型：
--
作者：
Silliman, CC;Boshkov, LK;Ambruso, DR
输血相关急性肺损伤(TRALI)是血液治疗中一种危及生命的并发症。我们报告了81例患者输注全血血小板(72例)、分离血小板(2例)、红细胞压积(15例)和血浆(1例)后发生的一系列90次TRALI反应。总体患病率为1120个细胞成分中有1个。为了研究TRALI的流行病学，我们对前46名TRALI患者和225名接受输血的对照组进行了嵌套式病例对照研究。然后，我们完成了对51例TRALI患者可能的生物反应修饰物的前瞻性分析，包括人类白细胞抗原(HILA)1类、11类、供体中的粒细胞抗体以及受累单位和受者血浆中的中性粒细胞(PMN)启动活性。有两组患者面临风险：血液系统恶性肿瘤患者(P<；.0004)和心脏病患者(P<；.0006)。TRALI与年龄较大的血小板相关(P=0.014)。在前瞻性研究中，只有3.6%的病例发现了抗白细胞抗体。相关血液成分的PMN启动活性高于对照组(P<；0.05)，与输血前相比，TRALI患者血浆中IL-6和脂质(中性脂和溶血磷脂酰胆碱)启动活性均升高(P<；0.05)。我们的结论是，TRALI可能比以前认识到的更常见，患者的易感性、产品年龄和成分中生物活性脂水平的增加可能使患者易患TRALI，就像急性呼吸窘迫综合征一样，可能是一个两事件现象，接受者的易感性和存储单元中的因素发挥了主要作用。(C)2003年，由美国血液病学会提供。
Transfusion-related acute lung injury (TRALI) is a life-threatening complication of hemotherapy. We report a series of 90 TRALI reactions in 81 patients secondary to transfusion with whole blood platelets (72 reactions), apheresis platelets (2), packed red cells (15), and plasma (1). The overall prevalence was 1 in 1120 cellular components. To examine the epidemiology of TRALI, we completed a nested case-control study of the first 46 patients with TRALI compared with 225 controls who had received transfusions. We then completed a prospective analysis of possible biologic response modifiers responsible for 51 of the TRALI cases, including human leukocyte antigen (HILA) class 1, class 11, and granulocyte antibodies in donors and neutrophil (PMN) priming activity in the plasma of the implicated units and recipients. Two groups were at risk: patients with hematologic malignancies (P < .0004) and patients with cardiac disease (P < .0006). TRALI was associated with older platelets (P = .014). In the prospective study, antileukocyte antibodies were found in only 3.6% of cases. The implicated blood components had greater PMN priming activity than controls (P < .05), and compared with pretransfusion samples, TRALI patients' plasma demonstrated increases in both interleukin 6 (IL-6) and lipid (neutral lipids and lysophosphatldylcholines) priming activity (P < .05). We conclude that TRALI may be more frequent than previously recognized and that patient susceptibility, product age, and increased levels of bioactive lipids in components may predispose patients to TRALI TRALI, like the acute respiratory distress syndrome, may be a 2-event phenomenon with both recipient predisposition and factors in the stored units playing major roles. (C) 2003 by The American Society of Hematology.