Transfusion-related acute lung injury - Report of a clinical look-back investigation
Transfusion-related acute lung injury - Report of a clinical look-back investigation
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DOI：
10.1001/jama.287.15.1968
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发表时间：
2002-04-17
影响因子：
120.7
通讯作者：
Popovsky, MA
中科院分区：
文献类型：
--
作者：
Kopko, PM;Marshall, CS;Popovsky, MA
输血相关急性肺损伤（TRALI）是一种包括呼吸困难、低血压、双侧肺水肿和发热的综合征。TRALI是输血相关死亡的第三大原因，但它可能被低估和漏报。目的确定是否血液制品从频繁的血浆供体，其血液制品牵连到TRALI的致命案件，引起TRALI的症状，在其他收件人的血浆。设计，设置，回顾性病历审查（从2000年11月至2001年4月进行）的50名患者在2年内接受血液成分（1998年10月至2000年10月）与输血相关死亡有关的献血者。（呼吸困难伴发热、寒战、低血压，和/或低氧血症）或严重（急性肺水肿或需要机械通气）结果14例患者因叠加疾病而无法进行TRALI评估。在可审查的36例患者病历中，6例患者（16.7%）报告了7例轻度/中度反应，8例患者（22.2%）报告了8例重度反应。在接受来自同一供体的多次输血的5例患者中，2例发生2例反应：1例发生2例轻度/中度反应，另1例同时发生轻度/中度和重度反应。虽然7例轻度/中度反应中有5例报告给医院输血服务部门，但8例重度反应中仅报告了2例。只有2个反应（1个轻度/中度和1个严重）报告给区域血液采集facility.Conclusions TRALI经常被低估，并在血液制品的受者从一个捐助者的血液制品可能会导致TRALI在几个输血受体。临床教育和认识这一经常被忽视的诊断是必要的适当预防和治疗。
Context Transfusion-related acute lung injury (TRALI) is a syndrome that includes dyspnea, hypotension, bilateral pulmonary edema, and fever. TRALI is the third leading cause of transfusion-related mortality, but it is probably underdiagnosed and underreported.Objective To determine if blood products from a frequent plasma donor, whose blood product was implicated in a fatal case of TRALI, caused symptoms of TRALI in other recipients of her plasma.Design, Setting, and Participants Retrospective chart review (conducted from November 2000 through April 2001) of 50 patients who received blood components within 2 years (October 1998 through October 2000) from a donor linked to a transfusion-related fatality.Main Outcome Measure Occurrence of mild/moderate (dyspnea with fever, chills, hypotension, and/or hypoxemia) or severe (acute pulmonary edema or need for mechanical ventilation) reaction associated with transfusion.Results Superimposed illness prevented assessment of TRALI in 14 patients. Of the 36 patient charts that could be reviewed, 7 mild/moderate reactions were reported in 6 patients (16.7%) and 8 severe reactions were reported in 8 patents (22.2%). Of 5 patients who received multiple transfusions from the same donor, 2 experienced 2 reactions: one had 2 mild/moderate reactions and the other had both a mild/moderate and a severe reaction. While 5 of the 7 mild/moderate reactions were reported to the hospital transfusion service, only 2 of the 8 severe reactions were reported. Only 2 reactions (1 mild/ moderate and 1 severe) were reported to the regional blood collection facility.Conclusions TRALI was frequently underdiagnosed and underreported in recipients of blood products from a donor whose blood products may have caused TRALI in several transfusion recipients. Clinical education and awareness of this often-overlooked diagnosis are imperative for appropriate prevention and treatment.