Is transfusion safe?

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Halıcı A.

3rd INTERNATIONAL CONGRESS ON EMERGENCY MEDICINE “ICON-EM, Antalya, Turkey, 5 - 08 November 2023, pp.329-330

  • Publication Type: Conference Paper / Full Text
  • City: Antalya
  • Country: Turkey
  • Page Numbers: pp.329-330
  • Kütahya Health Sciences University Affiliated: Yes


Is transfusion safe?


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.

Notlar (Opsiyonel): KAYNAKLAR1.Dodd RY, Notari EP 4th, Stramer SL. Current prevalence and incidence of infectious disease markers and estimated window-period risk in the American Red Cross blood donor population. Transfusion 2002; 42:975-979.2.Eder AF. Transfusion-related acute lung injury. Program and abstracts of the 71st Annual Meeting of the American Society for Clinical Laboratory Science; July 22-26, 2003; Philadelphia, Pennsylvania3.Popovsky MA, Chaplin HC Jr, Moore SB. Transfusion-related acute lung injury: a neglected, serious complication of hemotherapy. Transfusion 1992;32:589-592.4.Wallis JP. Transfusion-related acute lung injury (TRALI)--under-diagnosed and under-reported. Br J Anaesth 2003;90:573-5765.Popovsky MA, Moore SB. Diagnosis and pathogenic considerations in transfusion-related acute lung injury. Transfusion 1985;25:573-5776.Kleinman S, Caulfield T, Chan P, et al. Toward an understanding of transfusion-related acute lung injury: statement of a consensus panel. Transfusion 2004; 44:17747.Popovsky MA, Davenport RD. Transfusion-related acute lung injury: femme fatale? Transfusion 2001; 41: 312-58.Toy P, Popovsky MA, Abraham E, et al. Transfusion-related acute lung injury: definition and review. Crit Care Med 2005; 33:7219.ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012; 307:2526.10.Holness L, Knippen MA, Simmons L, Lachenbruch PA. Fatalities caused by TRALI. Transfus Med Rev 2004; 18:18411.Lieberman L, Petraszko T, Yi QL, et al. Transfusion-related lung injury in children: a case series and review of the literature. Transfusion 2014; 54:57. 12.Silliman CC, Ambruso DR, Boshkov LK. Transfusion-related acute lung injury. Blood 2005; 105:226613.Vlaar AP, Binnekade JM, Prins D, et al. Risk factors and outcome of transfusion-related acute lung injury in the critically ill: a nested case-control study. Crit Care Med 2010; 38:771.14.Gajic O, Rana R, Winters JL, et al. Transfusion-related acute lung injury in the critically ill: prospective nested case-control study. Am J Respir Crit Care Med 2007; 176:886


  : acute lung injury , blood transfusion , TRALI