Perioperative transfusion-related acute lung injury: The Canadian Blood Services experience.

Transfusion-related acute lung injury (TRALI) is a serious complication of blood transfusion. In immunogenic TRALI transfused donor antibodies – mostly from plasma products – are responsible for causing acute lung insufficiency. As a consequence some national blood transfusion services have banned female plasma for transfusion while others test for HLA- and HNA-antibodies in donors with a medical history of immunization, e.g. pregnancy or blood transfusion. However, triggers of non-immunogenic TRALI are still a matter of debate.

In the present retrospective study suspected perioperative and non-perioperative TRALI cases reported to Canadian Blood Services between 2001 2012 were analysed. Of 303 definite, possible or inconclusive cases, 38% were identified as occurring during the perioperative period. Perioperative TRALI patients were transfused more plasma (152 versus 105; p = 0.013) than non-perioperative TRALI patients.

These data support the notion that perioperative TRALI patients have a “first hit” prior to their non-immunogenic TRALI event. Perioperative TRALI patients were more often in the ICU and needed mechanical ventilation or supplemental oxygen more frequently at baseline. A “second hit” caused by biologically active lipids released from blood components during storage may result in non-immunogenic TRALI.

Physicians should be aware of the at-risk characteristics of these perioperative patients.

– Rainer Moog

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