Diagnosis of transfusion-related acute lung injury: TRALI or not TRALI?
Diagnosis of transfusion-related acute lung injury: TRALI or not TRALI?
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输血相关急性肺损伤的诊断：TRALI 还是不 TRALI？
DOI：
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发表时间：
2006
影响因子：
0.8
通讯作者：
F. Grumet
中科院分区：
文献类型：
--
作者：
M. Fontaine;J. Malone;Franklin M. Mullins;F. Grumet
TRALI对于输血专家和临床医生来说都是一个具有挑战性的诊断。加拿大的一个共识小组最近提出了更好地界定TRALI及其影响的准则。该指南建议将每个疑似病例分为以下3类之一：（1）“TRALI”，（2）“可能的TRALI”或（3）“非TRALI”。我们报告了3例异体输血后呼吸衰竭（RF）患者的临床表现、实验室评估和治疗。这些患者均在输血后6小时内发生RF。基于临床和实验室数据的回顾，并应用加拿大指南，第一名患者，一名67岁的男性慢性粒单核细胞白血病，被诊断为“TRALI”，由于RF的突然发作，需要强化复苏。第二例患者是一名55岁的再生障碍性贫血男性，由于既存RF在输血后恶化，被诊断为“可能TRALI”。第3例患者为1岁男性，诊断为输血相关循环超负荷（TACO）和“可能TRALI”，尽管他的RF在利尿剂治疗后有所改善。在所有3例病例中，将疑似TRALI反应告知献血中心。与这些反应相关的献血者的剩余血液制品已被隔离。在审查临床数据后，血液中心对与病例#1和#3相关的供体进行了粒细胞和HLA抗体筛查。使用Luminex流式微珠阵列，在相应供体中鉴定了对患者#1具有特异性的以下I类和II类抗体：抗A25、B8、B18和抗DR 15、DR 17。随后，供体#1被永久推迟。在与病例#3相关的供体中鉴定出非特异性IgM抗粒细胞抗体，随后该供体被取消了血浆和血小板捐献资格。总之，加拿大对疑似TRALI患者进行分类的指南为评估这些患者及其各自的献血者提供了有用的框架。
TRALI is a challenging diagnosis for both the transfusion specialist and the clinician. A Canadian consensus panel has recently proposed guidelines to better define TRALI and its implications. The guidelines recommend classifying each suspected case in one of the following 3 categories: (1) "TRALI," (2) "Possible TRALI," or (3) "Not TRALI." We report the clinical presentation, laboratory evaluation, and management of 3 patients with respiratory failure (RF) following allogeneic blood transfusions. These patients all experienced RF within 6 hr post-transfusion. Based on a review of the clinical and laboratory data and applying the Canadian guidelines, the first patient, a 67-yr-old man with chronic myelomonocytic leukemia, was diagnosed as "TRALI" due to the sudden onset of RF requiring intensive resuscitation. The second patient, a 55-yr-old man with aplastic anemia, was diagnosed as "Possible TRALI" due to pre-existing RF that worsened after blood transfusion. The third patient, a 1-yr-old male, was diagnosed as transfusion associated circulatory overload (TACO) and "Possible TRALI," although his RF improved after treatment with diuretics. In all 3 cases, the blood donor center was informed of the suspected TRALI reactions. The remaining blood products from the donors associated with these reactions were quarantined. After review of the clinical data, the donors associated with cases #1 and #3 were screened by the blood center for granulocyte and HLA antibodies. Using a Luminex flow bead array, the following class I and class II antibodies specific for patient #1 were identified in the respective donor: anti-A25, B8, B18, and anti-DR15, DR 17. Subsequently, donor #1 was permanently deferred. A non-specific IgM anti-granulocyte antibody was identified in the donor associated with case #3, and this donor was subsequently disqualified from plasma and platelet donations. In conclusion, the Canadian guidelines to categorize patients suspected of TRALI provide a useful framework for evaluation of these patients and their respective blood donors.
影响因子：
20.3
作者：
Silliman, CC;Boshkov, LK;Ambruso, DR
通讯作者：
Ambruso, DR