Research Information System
3rd INTERNATIONAL CONGRESS ON EMERGENCY MEDICINE “ICON-EM, Antalya, Turkey, 5 - 08 November 2023, pp.329-330, (Full Text)
Is transfusion safe?
ALİ HALICI1
1Kutahya Health Sciences University
Background and aim: Blood transfusion is a frequently
performed procedure in the emergency department. Although this procedure is
mostly uncomplicated, undesirable side effects may also occur. Allergy,
anaphylaxis, hemolytic reaction, and transfusion-related acute lung injury
(TRALI) may occur. The diagnosis of TRALI is a clinical diagnosis and it is
necessary to make a rapid diagnosis and start treatment early. When TRALI is
suspected, transfusion should be stopped immediately, vital signs and
respiratory status should be assessed, and chest imaging should be performed.
The transfusion medicine service should be notified that TRALI is suspected.
Therapy is supportive with oxygen and respiratory support along with
lung-protective strategies when clinically indicated.
Case: A 63-year-old female patient was referred to the
emergency room due to low blood pressure. He is being followed up due to known
chronic kidney disease. The Hbg value checked by the family doctor to whom he
applied with complaints of fatigue was measured as 6.3. The patient, whose
vitals were stable and urine output was present, was given erythrocyte
suspension(ES) to treat his symptomatic anemia.. During the treatment of erythrocyte
suspension, the patient developed tachypnea and shortness of breath.The
patient's saturation was low with 3 lt/min oxygen saturation: 80%
TA:200/120mm/hg and the body became cyanotic. The patient was placed on
non-invasive mechanical ventilation and treatment was started with a
preliminary diagnosis of TRALI and he was admitted to the intensive care unit.
Decisions: The respiratory distress that develops after
the transfusion of blood and blood products is called "Transfusion Related
Acute Lung Injury" (TRALI). Although its prevalence is not known exactly,
it is estimated to be between 1/5000 and 1/300. This complication, which can be
fatal at a rate of 10%, is the most common cause of transfusion-related death
after hemolytic reactions (1-5). The most critical point in the diagnosis of
acute lung injury is the stage of considering the diagnosis and then making an
effective differential diagnosis.TRALI should be considered when a patient
develops hypoxemic respiratory failure during or immediately after the
transfusion of any blood product(6). Its incidence has been reported as 1 in
5000 transfusions(7). Transfusion-related acute lung injury is a serious and
potentially fatal complication of blood product transfusion; The patient
develops rapid-onset lung damage and non-cardiogenic pulmonary edema due to the
activation of immune cells in the lungs (6,8). Many additional signs and
symptoms associated with non-cardiogenic pulmonary edema and inflammation may
occur. It can be severe enough to be life-threatening, with fever, chills, and
hypoxemic respiratory failure. There are 2 types: TRALI type I occurs in
patients without concomitant risk factors for acute respiratory distress
syndrome (ARDS). TRALI type II occurs in patients with concomitant risk factors
for ARDS or in patients with mild ARDS but in whom acute deterioration in
respiratory status is believed to be due to the transfusion event. Therefore,
the presence of mild ARDS before transfusion no longer excludes the diagnosis
of TRALI(9). Although the time frame for onset of clinical symptoms remains
within six hours after transfusion, abnormal chest imaging results may occur up
to 24 hours after TRALI onset. TRALI occurs essentially equally in all age
groups and in both genders (3,10,11). Symptoms may be delayed for up to six
hours, but usually begin within one to two hours after initiating the blood
component infusion(6,12). Initial descriptions detailing the clinical course of
TRALI indicate that hypoxemia appears to resolve rapidly, usually within 24 to
48 hours after symptom onset(5). However, the majority of patients who develop
TRALI need to be admitted to the intensive care unit and require ventilator
support (13,14). It should be considered that transfusion-related lung injury
(TRALI) may have developed in any patient who develops respiratory distress
within six hours of transfusion. When transfusion-related lung injury is
diagnosed early, satisfactory results are obtained with supportive treatments.
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Keywords
: acute lung
injury , blood transfusion , TRALI