Transfusion-Related Acute Lung Injured (TRALI): Current Concepts.
Transfusion-Related Acute Lung Injured (TRALI): Current Concepts.
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DOI：
10.2174/1874306401509010092
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Castillo RL
中科院分区：
文献类型：
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作者：
Álvarez P;Carrasco R;Romero-Dapueto C;Castillo RL
输血相关急性肺损伤（TRALI）是一种危及生命的干预措施，在输血一个或多个单位血液后6小时内发生，是输血引起发病率和死亡率的重要原因。有必要排除急性肺损伤（ALI）的其他原因，如败血症、急性心源性水肿、急性呼吸窘迫综合征（ARDS）或细菌感染。有两种机制导致该综合征的发展：免疫介导和无免疫介导的TRALI。在实验性TRALI模型中，一个共同的主题是中性粒细胞在介导早期免疫反应和肺血管损伤中的核心重要性。中心临床症状为呼吸困难、呼吸急促、心动过速、发绀和肺分泌物，并伴有其他血流动力学改变，如低血压和发烧。与这些临床发现相辅相成的是，长期有效的TRALI动物模型应该能够确定TRALI诱导的同种异体抗体的细胞靶标，以及描述潜在的致病分子机制和病理的关键分子介质。已经制定了诊断标准，并实施了预防措施。这些行动有助于减少死亡总人数。然而，TRALI仍然是一个临床问题。任何疑似TRALI并发症应立即报告。
Transfusion-related acute lung injury (TRALI) is a life-threatening intervention that develops within 6 hours of transfusion of one or more units of blood, and is an important cause of morbidity and mortality resulting from transfusion. It is necessary to dismiss other causes of acute lung injury (ALI), like sepsis, acute cardiogenic edema, acute respiratory distress syndrome (ARDS) or bacterial infection. There are two mechanisms that lead to the development of this syndrome: immune-mediated and no immune- mediated TRALI. A common theme among the experimental TRALI models is the central importance of neutrophils in mediating the early immune response, and lung vascular injury. Central clinical symptoms are dyspnea, tachypnea, tachycardia, cyanosis and pulmonary secretions, altogether with other hemodynamic alterations, such as hypotension and fever. Complementary to these clinical findings, long-term validated animal models for TRALI should allow the determination of the cellular targets for TRALI-inducing alloantibodies as well as delineation of the underlying pathogenic molecular mechanisms, and key molecular mediators of the pathology. Diagnostic criteria have been established and preventive measures have been implemented. These actions have contributed to the reduction in the overallnumber of fatalities. However, TRALI still remains a clinical problem. Any complication suspected of TRALI should immediately be reported.