1
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Yu Z, Mao Z, Xiuyun L, Tianhua J. Transfusion-related acute lung injury induced by human leucocyte antigen-II antibodies: Analysis of antibody typing and source. Vox Sang 2024. [PMID: 38925642 DOI: 10.1111/vox.13703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND AND OBJECTIVES To explore transfusion-related acute lung injury (TRALI) induced by human leucocyte antigen (HLA)-II antibodies, and to analyse antibody typing and source. MATERIALS AND METHODS We retrospectively analysed the clinical symptoms and signs of two leukaemia patients with suspected TRALI from the same female donor. HLA phenotyping was performed on the two patients, the platelet donor, her husband and her two children. The HLA and human neutrophil antigen antibodies in the donor's plasma were identified. RESULTS The clinical manifestations of two leukaemia patients were those of TRALI, and we treated them with timely ventilator support. A high titre of HLA-II antibodies was in the plasma of the platelet donor. The antibodies were directed at HLA-DRB3*03:01, HLA-DRB1*09:01, HLA-DRB1*12:02, HLA-DRB3*01:01 and HLA-DRB1*12:01:01G, which were specific to the HLA antigens of the two patients. High-resolution HLA genotyping suggested that the donor's HLA-II antibodies were derived from immune stimulation by the husband's antigens during pregnancy. CONCLUSIONS This study described two cases of TRALI caused by HLA-II antibodies from the same female donor. Appropriate management of blood donors with a history of multiple pregnancies is crucial.
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Affiliation(s)
- Zou Yu
- Deyang People's Hospital, Deyang, Sichuan, China
| | - Zheng Mao
- Deyang People's Hospital, Deyang, Sichuan, China
| | - Liao Xiuyun
- Deyang Central Blood Station, Deyang, Sichuan, China
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2
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Cavaco MJ, Santos MJ, Paula F, Froes F. TRALI: A differential diagnosis to keep in mind. Pulmonology 2023:S2531-0437(23)00236-2. [PMID: 38129239 DOI: 10.1016/j.pulmoe.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Affiliation(s)
- M J Cavaco
- Serviço de Pneumologia, Centro Hospitalar do Oeste, Torres Vedras, Portugal.
| | - M J Santos
- Serviço de Pneumologia, Centro Hospitalar Lisboa Norte, Hospital Pulido, Valente, Portugal
| | - F Paula
- Serviço de Pneumologia, Centro Hospitalar Lisboa Norte, Hospital Pulido, Valente, Portugal
| | - F Froes
- Serviço de Pneumologia, Centro Hospitalar Lisboa Norte, Hospital Pulido, Valente, Portugal
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3
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Liu Y, Wang R, Song C, Ding S, Zuo Y, Yi K, Li N, Wang B, Geng Q. Crosstalk between neutrophil extracellular traps and immune regulation: insights into pathobiology and therapeutic implications of transfusion-related acute lung injury. Front Immunol 2023; 14:1324021. [PMID: 38162674 PMCID: PMC10755469 DOI: 10.3389/fimmu.2023.1324021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-associated death, occurring during or within 6 hours after transfusion. Reports indicate that TRALI can be categorized as having or lacking acute respiratory distress syndrome (ARDS) risk factors. There are two types of TRALI in terms of its pathogenesis: antibody-mediated and non-antibody-mediated. The key initiation steps involve the priming and activation of neutrophils, with neutrophil extracellular traps (NETs) being established as effector molecules formed by activated neutrophils in response to various stimuli. These NETs contribute to the production and release of reactive oxygen species (ROS) and participate in the destruction of pulmonary vascular endothelial cells. The significant role of NETs in TRALI is well recognized, offering a potential pathway for TRALI treatment. Moreover, platelets, macrophages, endothelial cells, and complements have been identified as promoters of NET formation. Concurrently, studies have demonstrated that the storage of platelets and concentrated red blood cells (RBC) can induce TRALI through bioactive lipids. In this article, recent clinical and pre-clinical studies on the pathophysiology and pathogenesis of TRALI are reviewed to further illuminate the mechanism through which NETs induce TRALI. This review aims to propose new therapeutic strategies for TRALI, with the hope of effectively improving its poor prognosis.
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Affiliation(s)
- Yi Liu
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Rong Wang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Congkuan Song
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Song Ding
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yifan Zuo
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ke Yi
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ning Li
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bo Wang
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qing Geng
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
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4
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Kometani S, Misawa R, Kawai M, Seki H, Tabata M. A Case Report of Inhaled Nitric Oxide for Transfusion-Related Acute Lung Injury. Cureus 2023; 15:e41552. [PMID: 37554622 PMCID: PMC10405555 DOI: 10.7759/cureus.41552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2023] [Indexed: 08/10/2023] Open
Abstract
Transfusion-related acute lung injury (TRALI) is an acute respiratory distress syndrome (ARDS) occurring during or within six hours after transfusion. On the other hand, while inhaled nitric oxide (iNO) temporarily improves arterial oxygenation with selective pulmonary vasodilation, there is no evidence of mortality reduction in ARDS. We herein report a case in which TRALI was diagnosed with severe hypoxemia during cardiovascular surgery, and extracorporeal membrane oxygenation (ECMO) was avoided by using iNO for respiratory management. Administering iNO to patients with acute respiratory failure may be useful as a bridging therapy to help patients recover. However, further evidence is needed before this treatment can become standard practise.
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Affiliation(s)
| | - Ryo Misawa
- Anesthesiology, Yamato Seiwa Hospital, Yamato, JPN
| | | | - Hiroshi Seki
- Cardiovascular Surgery, Yamato Seiwa Hospital, Yamato, JPN
| | - Mimiko Tabata
- Cardiovascular Surgery, Yamato Seiwa Hospital, Yamato, JPN
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5
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Groten SA, Smit ER, Janssen EFJ, van den Eshof BL, van Alphen FPJ, van der Zwaan C, Meijer AB, Hoogendijk AJ, Biggelaar MVD. Multi-omics delineation of cytokine-induced endothelial inflammatory states. Commun Biol 2023; 6:525. [PMID: 37188730 PMCID: PMC10184633 DOI: 10.1038/s42003-023-04897-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/02/2023] [Indexed: 05/17/2023] Open
Abstract
Vascular endothelial cells (ECs) form a dynamic interface between blood and tissue and play a crucial role in the progression of vascular inflammation. Here, we aim to dissect the system-wide molecular mechanisms of inflammatory endothelial-cytokine responses. Applying an unbiased cytokine library, we determined that TNFα and IFNγ induced the largest EC response resulting in distinct proteomic inflammatory signatures. Notably, combined TNFα + IFNγ stimulation induced an additional synergetic inflammatory signature. We employed a multi-omics approach to dissect these inflammatory states, combining (phospho-) proteome, transcriptome and secretome and found, depending on the stimulus, a wide-array of altered immune-modulating processes, including complement proteins, MHC complexes and distinct secretory cytokines. Synergy resulted in cooperative activation of transcript induction. This resource describes the intricate molecular mechanisms that are at the basis of endothelial inflammation and supports the adaptive immunomodulatory role of the endothelium in host defense and vascular inflammation.
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Affiliation(s)
- Stijn A Groten
- Department of Molecular Hematology, Sanquin Research, Amsterdam, 1066 CX, The Netherlands
| | - Eva R Smit
- Department of Molecular Hematology, Sanquin Research, Amsterdam, 1066 CX, The Netherlands
| | - Esmée F J Janssen
- Department of Molecular Hematology, Sanquin Research, Amsterdam, 1066 CX, The Netherlands
| | - Bart L van den Eshof
- Department of Molecular Hematology, Sanquin Research, Amsterdam, 1066 CX, The Netherlands
| | - Floris P J van Alphen
- Department of Molecular Hematology, Sanquin Research, Amsterdam, 1066 CX, The Netherlands
| | - Carmen van der Zwaan
- Department of Molecular Hematology, Sanquin Research, Amsterdam, 1066 CX, The Netherlands
| | - Alexander B Meijer
- Department of Molecular Hematology, Sanquin Research, Amsterdam, 1066 CX, The Netherlands
- Department of Biomolecular Mass Spectrometry and Proteomics, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, 3584 CS, The Netherlands
| | - Arie J Hoogendijk
- Department of Molecular Hematology, Sanquin Research, Amsterdam, 1066 CX, The Netherlands
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6
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Watanabe Y, Miyagi M, Kaneda T. Anesthetic Management of a Patient With Massive Pulmonary Secretion During Cardiopulmonary Bypass Probably Due to Transfusion-Related Acute Lung Injury Type Ⅱ. Cureus 2023; 15:e37405. [PMID: 37182034 PMCID: PMC10171924 DOI: 10.7759/cureus.37405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Transfusion-related acute lung injury (TRALI) is potentially life-threatening adverse reaction associated with blood transfusion and can induce perioperative pulmonary secretion. TRALI that develops during cardiopulmonary bypass (CPB) may be difficult to detect; however, the pathophysiology might manifest as derangements in CPB operations. A 79-year-old man was scheduled to undergo partial replacement of the aortic arch with CPB. Two units of red blood cells were loaded into the priming solution. Although the vital signs, including oxygenation, remained stable in the prebypass period, perfusionists noticed a decreasing trend in the venous reservoir level early in the CPB operations. The trend continued even during circulatory arrest with selective cerebral perfusion, resulting in the termination of the modified hemofiltration. Surgical procedures were accomplished uneventfully; however, a large amount of fluid was required to maintain the minimal reservoir level and CPB flow. The total fluid balance during CPB was +8,233 mL, which was quite unusual in our practice. When 800 mL of massive pulmonary secretion was detected before CPB withdrawal, the etiology could not be determined simultaneously; nonetheless, systemic vascular hyperpermeability was speculated to be the underlying pathophysiology. Our therapeutic approach following the treatment of acute respiratory distress syndrome contributed to halting the deterioration of lung injury. Although the pneumothorax developed on the first postoperative day, the patient was treated with the insertion of a chest drainage tube. Subsequently, the patient had a good course and was discharged without respiratory complications. In conclusion, massive pulmonary secretion, probably due to TRALI type II, was associated with derangements in CPB operations. Prompt identification of the underlying pathophysiology and appropriate intervention is crucial.
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Affiliation(s)
- Yasuhiro Watanabe
- Department of Anesthesia, Japanese Red Cross Shizuoka Hospital, Shizuoka, JPN
| | - Mitsumasa Miyagi
- Department of Anesthesia, Japanese Red Cross Shizuoka Hospital, Shizuoka, JPN
| | - Toru Kaneda
- Department of Anesthesia, Japanese Red Cross Shizuoka Hospital, Shizuoka, JPN
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7
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Klanderman RB, van Mourik N, Eggermont D, Peters AL, Tuinman PR, Bosman R, Endeman H, Cremer OL, Arbous SM, Vlaar APJ. Incidence of transfusion-related acute lung injury temporally associated with solvent/detergent plasma use in the ICU: A retrospective before and after implementation study. Transfusion 2022; 62:1752-1762. [PMID: 35919958 PMCID: PMC9544437 DOI: 10.1111/trf.17049] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 06/08/2022] [Accepted: 06/11/2022] [Indexed: 11/29/2022]
Abstract
Background Transfusion‐related acute lung injury (TRALI) is a severe complication of plasma transfusion, though the use of solvent/detergent pooled plasma (SDP) has nearly eliminated reported TRALI cases. The goal of this study was to investigate the incidence of TRALI in intensive care units (ICU) following the replacement of quarantined fresh frozen plasma (qFFP) by SDP. Study design and methods A retrospective multicenter observational before–after cohort study was performed during two 6‐month periods, before (April–October 2014) and after the introduction of SDP (April–October 2015), accounting for a washout period. A full chart review was performed for patients who received ≥1 plasma units and developed hypoxemia within 24 h. Results During the study period, 8944 patients were admitted to the ICU. Exactly 1171 quarantine fresh frozen plasma (qFFP) units were transfused in 376 patients, and respectively, 2008 SDP units to 396 patients after implementation. Ten TRALI cases occurred during the qFFP and nine cases occurred during the SDP period, in which plasma was transfused. The incidence was 0.85% (CI95%: 0.33%–1.4%) per unit qFFP and 0.45% (CI95%: 0.21%–0.79%, p = 0.221) per SDP unit. One instance of TRALI occurred after a single SDP unit. Mortality was 70% for patients developing TRALI in the ICU compared with 22% in patients receiving at least one plasma transfusion. Conclusion Implementation of SDP lowered the incidence of TRALI in which plasma products were implicated, though not significantly. Clinically diagnosed TRALI can still occur following SDP transfusion. Developing TRALI in the ICU was associated with high mortality rates, therefore, clinicians should remain vigilant.
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Affiliation(s)
- Robert B Klanderman
- Department of Intensive Care, Amsterdam University Medical Centers - AMC, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers - AMC, Amsterdam, The Netherlands.,Department of Anesthesiology, Amsterdam University Medical Centers - AMC, Amsterdam, The Netherlands
| | - Nielsvan van Mourik
- Department of Intensive Care, Amsterdam University Medical Centers - AMC, Amsterdam, The Netherlands
| | - Dorus Eggermont
- Department of Intensive Care, Amsterdam University Medical Centers - AMC, Amsterdam, The Netherlands
| | - Anna-Linda Peters
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter R Tuinman
- Department of Intensive Care, Amsterdam University Medical Centers - VUmc, Amsterdam, The Netherlands
| | - Rob Bosman
- Department of Intensive Care, Onze Lieve Vrouwe Gasthuis - Locatie Oost, Amsterdam, The Netherlands
| | - Henrik Endeman
- Department of Intensive Care, Onze Lieve Vrouwe Gasthuis - Locatie Oost, Amsterdam, The Netherlands
| | - Olaf L Cremer
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sesmu M Arbous
- Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care, Amsterdam University Medical Centers - AMC, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers - AMC, Amsterdam, The Netherlands
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8
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Klanderman RB, Bulle EB, Heijnen JWM, Allen J, Purmer IM, Kerkhoffs JLH, Wiersum-Osselton JC, Vlaar APJ. Reported transfusion-related acute lung injury associated with solvent/detergent plasma - A case series. Transfusion 2022; 62:594-599. [PMID: 35174882 PMCID: PMC9306621 DOI: 10.1111/trf.16822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 11/30/2022]
Abstract
Background Antibody‐mediated transfusion‐related acute lung injury (TRALI) is caused by donor HLA or HNA antibodies in plasma‐containing products. In the Netherlands 55,000 units of solvent/detergent plasma (SDP), a pooled plasma product, are transfused yearly. It's produced by combining plasma from hundreds of donors, diluting harmful antibodies. Due to a lack of reported cases following implementation, some have labeled SDP as “TRALI safe”. Study design and methods Pulmonary transfusion reactions involving SDP reported to the Dutch national hemovigilance network in 2016–2019 were reviewed. Reporting hospitals were contacted for additional information, cases with TRALI and imputability definite, probable, or possible were included and informed consent was sought. Results A total of three TRALI and nine TACO cases were reported involving SDP. The imputability of one TRALI case was revised from possible to unlikely and excluded; in one case no informed consent was obtained. We present a case description of TRALI following SDP transfusion in a 69‐year‐old male, 3 days following endovascular aortic aneurysm repair. The patient received one unit of SDP to correct a heparin‐induced coagulopathy, prior to removal of a spinal catheter post‐operatively. Within five hours he developed hypoxemic respiratory failure requiring intubation, hypotension, bilateral chest infiltrates, and leucopenia. The patient made a full recovery. Conclusion This case of TRALI, following transfusion of a single unit of SDP to a patient without ARDS risk factors, demonstrates that TRALI can occur with this product. Clinicians should remain vigilant and continue to report suspected cases, to help further understanding of SDP‐associated TRALI.
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Affiliation(s)
- Robert B Klanderman
- Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Esther B Bulle
- Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Judith Allen
- Department of Quality and Security, HagaZiekenhuis, The Hague, The Netherlands
| | - Ilse M Purmer
- Department of Intensive Care, HagaZiekenhuis, The Hague, The Netherlands
| | | | | | - Alexander P J Vlaar
- Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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9
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Tung JP, Chiaretti S, Dean MM, Sultana AJ, Reade MC, Fung YL. Transfusion-related acute lung injury (TRALI): Potential pathways of development, strategies for prevention and treatment, and future research directions. Blood Rev 2022; 53:100926. [DOI: 10.1016/j.blre.2021.100926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/01/2021] [Accepted: 12/30/2021] [Indexed: 02/08/2023]
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10
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Transfusion of target antigens to preimmunized recipients: a new mechanism in transfusion-related acute lung injury. Blood Adv 2021; 5:3975-3985. [PMID: 34438443 PMCID: PMC8945619 DOI: 10.1182/bloodadvances.2020003843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 09/04/2021] [Indexed: 01/13/2023] Open
Abstract
The recipients’ preformed alloantibodies may initiate TRALI reaction in recipients transfused with soluble antigen. The antibody interaction with absorbed antigen on ECs leads to endothelial barrier dysfunction and lung injury.
Transfusion-related lung injury (TRALI) is a serious side effect of blood transfusion. Exclusion of antibody carriers from the donor pool has significantly decreased the number of cases, but TRALI remains the leading cause of transfusion-related morbidity and mortality in industrialized countries. Here, we show that proteins released from donor cells during processing of blood components are capable of inducing a new type of reverse TRALI when transfused to preimmunized recipients. First, we show that soluble neutrophil surface protein CD177 in complex with proteinase 3 (sCD177/PR3) is not only present in human plasma but also in packed red blood cell (PRBC) supernatant. Filtration or storage enhances the concentration of sCD177/PR3 in PRBCs. Second, we show that sCD177/PR3 specifically binds to PECAM-1 on stimulated (but not on unstimulated) endothelial cells (ECs). Third, we provide evidence that the sCD177/PR3/PECAM-1 complex is functional. In the presence of monoclonal or human antibodies against CD177 or PR3, ECs produce reactive oxygen species and become apoptotic. Albumin flux through an EC monolayer increases significantly whenever antibodies and the cognate antigens are present. Finally, we describe a clinical case in which anti-CD177 present in a transfusion recipient precipitated TRALI after the transfusion of CD177-positive, but not CD177-negative, PRBCs. In conclusion, we introduce a new TRALI mechanism based on the specific binding of transfused, soluble antigens to activated ECs in preimmunized recipients. We suggest that further studies and clinical work-up of TRALI should also include antibody investigation of the recipient.
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11
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Yokoyama A, Sakamoto Y, Jo T, Urushiyama H, Tamiya H, Tanaka G, Matsui H, Fushimi K, Yasunaga H, Nagase T. Pulmonary disease as a risk factor for transfusion-related acute lung injury. ERJ Open Res 2021; 7:00039-2021. [PMID: 34476252 PMCID: PMC8405876 DOI: 10.1183/23120541.00039-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/20/2021] [Indexed: 12/03/2022] Open
Abstract
Transfusion-related acute lung injury (TRALI) is a severe condition characterised by noncardiogenic pulmonary oedema that develops within 6 h of blood transfusion. Patient factors and blood products have both been implicated in the development of TRALI; however, the role of pulmonary disease has not been investigated. We aimed to determine whether pulmonary disease is a risk factor for TRALI. We conducted a nested case-control study using data from the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan, between July 2010 and March 2015. Case patients who developed TRALI were 1:4-matched with control patients for sex, age and same hospital for receipt of blood transfusion. We conducted a multivariable conditional logistic regression analysis to evaluate the associations of TRALI with various factors including comorbidities, body mass index (BMI) and plasma-containing blood products. We identified 2 019 501 hospitalised patients who received a blood transfusion. Among these patients, 72 developed TRALI. The 72 case patients had higher proportions of haematological malignancy, trauma and interstitial lung disease (ILD) than the 288 matched control patients. The multivariable conditional logistic regression analysis showed that occurrence of TRALI was associated with ILD (odds ratio, 3.88; 95% confidence interval, 1.11–13.6), BMI ≥25.0 kg·m−2 (2.10; 1.05–4.24) and plasma-containing blood products (1.94; 1.10–3.42), but not with infectious lung disease or obstructive airway disease. In conclusion, ILD was an independent risk factor for the development of TRALI. Physicians should be aware of the increased risk of TRALI in patients with ILD. Physicians should be aware of the risk of developing transfusion-related acute lung injury when performing a blood transfusion in patients with interstitial lung disease.https://bit.ly/3jdoZQP
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Affiliation(s)
- Akira Yokoyama
- Dept of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukiyo Sakamoto
- Dept of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- Dept of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Dept of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hirokazu Urushiyama
- Dept of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Tamiya
- Dept of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Goh Tanaka
- Dept of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Dept of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Dept of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Dept of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Takahide Nagase
- Dept of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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12
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Guo K, Ma S. The Immune System in Transfusion-Related Acute Lung Injury Prevention and Therapy: Update and Perspective. Front Mol Biosci 2021; 8:639976. [PMID: 33842545 PMCID: PMC8024523 DOI: 10.3389/fmolb.2021.639976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/05/2021] [Indexed: 12/14/2022] Open
Abstract
As an initiator of respiratory distress, transfusion-related acute lung injury (TRALI) is regarded as one of the rare complications associated with transfusion medicine. However, to date, the pathogenesis of TRALI is still unclear, and specific therapies are unavailable. Understanding the mechanisms of TRALI may promote the design of preventive and therapeutic strategies. The immune system plays vital roles in reproduction, development and homeostasis. Sterile tissue damage, such as physical trauma, ischemia, or reperfusion injury, induces an inflammatory reaction that results in wound healing and regenerative mechanisms. In other words, in addition to protecting against pathogens, the immune response may be strongly associated with TRALI prevention and treatment through a variety of immunomodulatory strategies to inhibit excessive immune system activation. Immunotherapy based on immune cells or immunological targets may eradicate complications. For example, IL-10 therapy is a promising therapeutic strategy to explore further. This review will focus on ultramodern advances in our understanding of the potential role of the immune system in TRALI prevention and treatment.
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Affiliation(s)
- Kai Guo
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shuxuan Ma
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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13
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Akagi Y, Murata S, Yamashita Y, Tanaka K, Hiroi T, Mushino T, Hosoi H, Nishikawa A, Tamura S, Sonoki T. Two Episodes of Transfusion-related Acute Lung Injury (TRALI) Occurring within a Short Period. Intern Med 2020; 59:2577-2581. [PMID: 32581159 PMCID: PMC7662060 DOI: 10.2169/internalmedicine.4700-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Transfusion-related acute lung injury (TRALI) is a non-hemolytic adverse reaction that occurs ≤6 hours after receiving a transfusion. A 72-year-old man with leukemia developed severe hypoxemia after platelet transfusions on two occasions within a 4-day period. During the first episode, the transfused platelet preparation was positive for anti-human-leukocyte antigen antibodies. The pathogenesis of TRALI includes an antibody-mediated mechanism and a non-antibody-mediated mechanism, in which various factors combine to activate pulmonary neutrophils. In our case, it is considered that the patient's neutrophils reached the activation threshold for the development of TRALI after the accumulation of various factors besides anti-leukocyte antibodies.
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Affiliation(s)
- Yuina Akagi
- Department of Hematology/Oncology, Wakayama Medical University, Japan
| | - Shogo Murata
- Department of Hematology/Oncology, Wakayama Medical University, Japan
| | - Yusuke Yamashita
- Department of Hematology/Oncology, Wakayama Medical University, Japan
| | - Ken Tanaka
- Department of Hematology/Oncology, Wakayama Medical University, Japan
| | - Takayuki Hiroi
- Department of Hematology/Oncology, Wakayama Medical University, Japan
| | - Toshiki Mushino
- Department of Hematology/Oncology, Wakayama Medical University, Japan
| | - Hiroki Hosoi
- Department of Hematology/Oncology, Wakayama Medical University, Japan
| | - Akinori Nishikawa
- Department of Hematology/Oncology, Wakayama Medical University, Japan
| | - Shinobu Tamura
- Department of Hematology/Oncology, Wakayama Medical University, Japan
| | - Takashi Sonoki
- Department of Hematology/Oncology, Wakayama Medical University, Japan
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14
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Grey S, Bolton-Maggs P. Pulmonary complications of transfusion: Changes, challenges, and future directions. Transfus Med 2020; 30:442-449. [PMID: 32924216 DOI: 10.1111/tme.12709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 11/27/2022]
Abstract
The pulmonary complications of transfusion (TACO, TRALI and TAD) are the leading cause of transfusion-related mortality and major morbidity. Advance in this area is essential in improving transfusion safety. This review describes the drivers for change in haemovigilance practice, the influence of recent key publications and future directions.
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Affiliation(s)
- Sharran Grey
- Lancashire Haematology Centre, Blackpool Teaching Hospitals NHS Foundation Trust, North Lancashire, UK.,Serious Hazards of Transfusion, Manchester Blood Centre, Manchester, UK
| | - Paula Bolton-Maggs
- Serious Hazards of Transfusion, Manchester Blood Centre, Manchester, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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15
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Budeyri A, Kocamer Simsek B, Yardimci MM, Anlatici R, Cankus MC. Management of a Multi-Level Forearm Microsurgical Reconstruction and the Following Transfusion-Related Acute Lung Injury. Cureus 2020; 12:e10385. [PMID: 33062506 PMCID: PMC7550022 DOI: 10.7759/cureus.10385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Transfusion-related acute lung injury (TRALI) is a clinical syndrome characterized by acute respiratory distress following blood transfusion. This case-based technical report documents a case on the management of a multi-level forearm microsurgical reconstruction and the following TRALI syndrome that developed shortly after blood transfusion in a 29-year-old male. Multilevel microsurgical revascularization was performed via saphenous vein autograft arterial reconstruction from the proximal 1/3 ulnar artery to the ulnar side of the deep superficial palmar arterial arch. TRALI was resolved with intensive care unit monitoring and treatment. There are several reports of TRALI in literature, as well as proposed mechanisms of pathogenesis, however, no case on the management of a multilevel forearm arterial reconstruction via a long saphenous vein autograft and associated TRALI syndrome have been reported.
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Affiliation(s)
- Aydin Budeyri
- Department of Orthopaedics and Traumatology, Sanko University, Gaziantep, TUR.,The Shoulder Center, Baylor University Medical Center at Dallas, Dallas, USA
| | | | | | - Recep Anlatici
- Department of Plastic Surgery, Sanko University, Gaziantep, TUR
| | - Mehmet C Cankus
- Department of Orthopaedics and Traumatology, Sanko University, Gaziantep, TUR
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16
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Incidence and risk factors of transfusion reactions in postpartum blood transfusions. Blood Adv 2020; 3:2298-2306. [PMID: 31366586 DOI: 10.1182/bloodadvances.2019000074] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/06/2019] [Indexed: 11/20/2022] Open
Abstract
Postpartum hemorrhages with blood transfusions are increasing in many high-resource countries. Currently, up to 3% of all women receive blood transfusion postpartum. Most blood transfusions are safe and, in many cases, are lifesaving, but there are significant concerns about adverse reactions. Pregnancy is associated with higher levels of leukocyte antibodies and has a modulating effect on the immune system. Our objective was to investigate whether blood transfusions postpartum are accompanied by an increased risk for transfusion reactions (TRs) compared with transfusions given to nonpregnant women. We included all women who gave birth in Stockholm County, Sweden between 1990 and 2011. Data from the Swedish National Birth Registry were linked to the Stockholm Transfusion Database and included information on blood components administered and whether a TR occurred in women who received blood transfusions postpartum. Background controls were nonpregnant women who received blood transfusions during the study period. The study cohort consisted of 517 854 women. Of these, 12 183 (2.4%) received a blood transfusion. We identified 96 events involving a TR postpartum, giving a prevalence of 79 per 10 000 compared with 40 per 10 000 among nonpregnant women (odds ratio, 2.0; 95% confidence interval, 1.6-2.5). Preeclampsia was the single most important risk factor for TRs (odds ratio, 2.1; 95% confidence interval, 1.7-2.6). We conclude that special care should be taken when women with preeclampsia are considered for blood transfusion postpartum, because our findings indicate that pregnancy is associated with an increased risk for TRs.
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17
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Hu A, Chen W, Wu S, Pan B, Zhu A, Yu X, Huang Y. An animal model of transfusion-related acute lung injury and the role of soluble CD40 ligand. Vox Sang 2020; 115:303-313. [PMID: 32064628 DOI: 10.1111/vox.12895] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 12/23/2019] [Accepted: 01/22/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Transfusion-related acute lung injury (TRALI) is a life-threatening complication of transfusion and is one of leading causes of transfusion-associated fatalities. However, the pathogenesis of TRALI is still unclear. Soluble CD40 ligand (sCD40L) is a proinflammatory cytokine that accumulates during blood component storage and is involved in transfusion reactions. The objective of this study was to establish a clinically relevant TRALI animal model and to evaluate the role of sCD40L in TRALI. MATERIALS AND METHODS Rats' red-blood-cell (RBC) suspensions were prepared, and the quality of RBC was evaluated. A trauma-haemorrhage-transfusion strategy was applied to build the animal model. Lung oedema was evaluated by histopathology examination, total bronchoalveolar lavage fluid (BALF) protein concentration, Evans blue dye (EBD) leakage and inflammatory cytokines. The sCD40L concentrations were measured. RESULTS Storage lesions of RBCs gradually increased over time. Obvious histological evidence of lung injury of rats transfused with a 35-day RBC was observed. The total BALF protein concentration, EBD leakage, inflammatory cytokines concentration were increased significantly in the Day 35 group. The sCD40L concentration increased significantly in the storage RBC suspension over time but was slightly elevated in rat plasma. CONCLUSIONS These findings indicated successful establishment of a TRALI animal model with trauma-haemorrhage-transfusion, in which sCD40L may play a minor role in the development of TRALI.
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Affiliation(s)
- Ai Hu
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Weiyun Chen
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Shubin Wu
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, China
| | - Boju Pan
- Department of Pathology, Peking Union Medical College Hospital, Beijing, China
| | - Afang Zhu
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Xuerong Yu
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China
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18
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Jongerius I, Porcelijn L, van Beek AE, Semple JW, van der Schoot CE, Vlaar APJ, Kapur R. The Role of Complement in Transfusion-Related Acute Lung Injury. Transfus Med Rev 2019; 33:236-242. [PMID: 31676221 PMCID: PMC7127679 DOI: 10.1016/j.tmrv.2019.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 01/02/2023]
Abstract
Transfusion-related acute lung injury (TRALI) is a life-threatening complication of acute respiratory distress occurring within 6 hours of blood transfusion. TRALI is one of the leading causes of transfusion-related fatalities and specific therapies are unavailable. Neutrophils are recognized as the major pathogenic cells, whereas T regulatory cells and dendritic cells appear to be important for protection against TRALI. The pathogenesis, however, is complex and incompletely understood. It is frequently postulated that the complement system plays an important role in the TRALI pathogenesis. In this article, we assess the evidence regarding the involvement of complement in TRALI from both human and animal studies. We hypothesize about the potential connection between the complement system and neutrophils in TRALI. Additionally, we draw parallels between TRALI and other acute pulmonary disorders of acute lung injury and acute respiratory distress syndrome regarding the involvement of complement. We conclude that, even though a role for complement in the TRALI pathogenesis seems plausible, studies investigating the role of complement in TRALI are remarkably limited in number and also present conflicting findings. Different types of TRALI animal models, diverse experimental conditions, and the composition of the gastrointestinal microbiota may perhaps all be factors which contribute to these discrepancies. More systematic studies are warranted to shed light on the contribution of the complement cascade in TRALI. The underlying clinical condition of the patient, which influences the susceptibility to TRALI, as well as the transfusion factor (antibody-mediated vs non–antibody-mediated), will be important to take into consideration when researching the contribution of complement. This should significantly increase our understanding of the role of complement in TRALI and may potentially result in promising new treatment strategies. Studies investigating complement and TRALI are limited in number and present conflicting findings. Systematic investigation is needed to better understand the contribution of the complement cascade in TRALI. Future studies in this area should consider both the clinical susceptibility of the patient as well as the effect of transfusion factors.
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Affiliation(s)
- Ilse Jongerius
- Sanquin Research, Department of Immunopathology, Amsterdam and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Emma Children's Hospital, Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Amsterdam UMC, Amsterdam, the Netherlands
| | - Leendert Porcelijn
- Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - Anna E van Beek
- Sanquin Research, Department of Immunopathology, Amsterdam and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Emma Children's Hospital, Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Amsterdam UMC, Amsterdam, the Netherlands
| | - John W Semple
- Division of Hematology and Transfusion Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - C Ellen van der Schoot
- Sanquin Research, Department of Experimental Immunohematology, Amsterdam and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine, Amsterdam UMC, AMC, Amsterdam, the Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Amsterdam UMC, AMC, Amsterdam, the Netherlands
| | - Rick Kapur
- Sanquin Research, Department of Experimental Immunohematology, Amsterdam and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
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19
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Kuldanek SA, Kelher M, Silliman CC. Risk factors, management and prevention of transfusion-related acute lung injury: a comprehensive update. Expert Rev Hematol 2019; 12:773-785. [PMID: 31282773 PMCID: PMC6715498 DOI: 10.1080/17474086.2019.1640599] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 07/03/2019] [Indexed: 12/13/2022]
Abstract
Introduction: Despite mitigation strategies that include the exclusion of females from plasma donation or the exclusion of females with a history of pregnancy or known anti-leukocyte antibody, transfusion-related acute lung injury (TRALI) remains a leading cause of transfusion-related morbidity and mortality. Areas covered: The definition of TRALI is discussed and re-aligned with the new Berlin Diagnostic Criteria for the acute respiratory distress syndrome (ARDS). The risk factors associated with TRALI are summarized as are the mitigation strategies to further reduce TRALI. The emerging basic research studies that may translate to clinical therapeutics for the prevention or treatment of TRALI are discussed. Expert opinion: At risk patients, including the genetic factors that may predispose patients to TRALI are summarized and discussed. The re-definition of TRALI employing the Berlin Criteria for ARDS will allow for increased recognition and improved research into pathophysiology and mitigation to reduce this fatal complication of hemotherapy.
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Affiliation(s)
- Susan A. Kuldanek
- The Division of Transfusion Medicine, School of Medicine University of Colorado Denver, Aurora, CO, USA
- Department of Pathology, School of Medicine University of Colorado Denver, Aurora, CO, USA
- Department of Pediatrics, School of Medicine University of Colorado Denver, Aurora, CO, USA
| | - Marguerite Kelher
- Department of Surgery, School of Medicine University of Colorado Denver, Aurora, CO, USA
| | - Christopher C. Silliman
- Department of Pediatrics, School of Medicine University of Colorado Denver, Aurora, CO, USA
- Department of Surgery, School of Medicine University of Colorado Denver, Aurora, CO, USA
- Vitalant Research Institute, Vitalant Mountain Division, Denver, CO, USA
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20
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Evidence of CD40L/CD40 pathway involvement in experimental transfusion-related acute lung injury. Sci Rep 2019; 9:12536. [PMID: 31467410 PMCID: PMC6715651 DOI: 10.1038/s41598-019-49040-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/05/2019] [Indexed: 01/04/2023] Open
Abstract
Platelet transfusions can cause adverse reactions in their recipients, including transfusion-related acute lung injury (TRALI). The pathophysiology of TRALI depends on a number of signaling pathways and the inflammatory role played by blood platelets remains controversial. Platelets are important in inflammation, particularly via the immunomodulator complex CD40/CD40L. We studied the specific function of the CD40/CD40L interaction in regulating an experimental TRALI Two-hit model. A mouse model of immune TRALI was triggered by injection of LPS and an anti-MHC I antibody, and the effect of injection of a neutralizing anti-CD40L antibody before induction of TRALI investigated. The characteristics of TRALI were decreased body temperature, pulmonary lesions, and immune cell infiltration into the alveolar space. Pulmonary infiltration was evaluated by blood counts of specific immune cells and their detection in lung sections. Inhibition of the CD40/CD40L immunomodulator interaction significantly reduced communication between immune and/or endothelial cells and the development of pulmonary edema. Hence, our results indicate that targeting of the CD40/CD40L interaction could be an important method to prevent TRALI. While considering that our work concerned a mouse model, we postulate that improvement of the conditions under which platelet concentrates are prepared/stored would assist in alleviating the risk of TRALI.
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21
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Weinstock C, Schnaidt M. Human Leucocyte Antigen Sensitisation and Its Impact on Transfusion Practice. Transfus Med Hemother 2019; 46:356-369. [PMID: 31832061 DOI: 10.1159/000502158] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/13/2019] [Indexed: 01/25/2023] Open
Abstract
Human leucocyte antigen (HLA) sensitisation, including the formation of antibodies against HLA, can cause serious effects in patients receiving blood. Under certain circumstances, donor HLA antibodies in the blood product can trigger the patient's granulocytes to release mediators that cause transfusion-associated lung injury (TRALI), a serious complication of transfusion. The HLA systems of both donor and patient are involved in transfusion-associated graft-versus-host disease, which is a rare disease with a high mortality. Patient HLA antibodies can destroy incompatible platelets and may cause refractoriness to platelet transfusion. Identification of a patient's HLA antibody specificities is necessary for issuing compatible platelets to overcome refractoriness. Many techniques for the detection and identification of HLA antibodies have been developed, including complement-dependent cytotoxicity assay, bead-based assays, the platelet adhesion immunofluorescence test, and the monoclonal antibody-specific immobilisation of platelet antigens assay. Different strategies for the selection of HLA-compatible platelets are applied. These strategies depend on the breadth of antibody reactivity and range from avoiding single HLA antigens in the platelet concentrates issued to apheresis of platelets from HLA-identical donors. The mechanisms of HLA sensitisation and the efforts made to provide compatible blood products to sensitised patients are reviewed in this article from the perspective of clinical transfusion medicine.
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Affiliation(s)
- Christof Weinstock
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service Baden-Württemberg-Hessen, Institute Ulm, Institute of Transfusion Medicine, Ulm University, Ulm, Germany
| | - Martina Schnaidt
- Centre for Clinical Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen, Tübingen, Germany
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22
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Beech C, Kumar D, Hendrickson J, Perincheri S, Tormey C, Bahar B. Cryoglobulinemia as a Possible Primer for TRALI: Report of a Case. Lab Med 2019; 50:313-319. [PMID: 30657960 DOI: 10.1093/labmed/lmy073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Waldenström macroglobulinemia (WM) is a form of lymphoplasmacytic lymphoma that can cause hyperviscosity syndrome due to unchecked monoclonal antibody production. Some patients are also found to have associated cryoglobulinemia, which can cause systemic complications including vasculitis, renal disease, and pulmonary complications. Cryoglobulins can also serve as a source of interference with various laboratory assays. Therapeutic plasma exchange (TPE) is one of the recommended treatment modalities to manage hyperviscosity. Herein, we present the case of an 84-year-old female patient with Waldenström macroglobulinemia who presented with hyperviscosity syndrome and discrepant laboratory findings, and who then developed transfusion-related acute lung injury (TRALI) during TPE. This case is one of many in the emerging possible linkages observed between cryoglobulinemia and TRALI.
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Affiliation(s)
- Cameron Beech
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT.,Department of Pathology, Yale University School of Medicine, New Haven, CT
| | - Deepika Kumar
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT.,Department of Pathology, Yale University School of Medicine, New Haven, CT
| | - Jeanne Hendrickson
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT.,Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Sudhir Perincheri
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
| | - Christopher Tormey
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT.,Department of Pathology and Laboratory Medicine Service, VA Connecticut Healthcare System, West Haven, CT
| | - Burak Bahar
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
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23
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Gürünlüoğlu K, Yıldırım İO, Kutlu R, Saraç K, Sığırcı A, Bağ HG, Demircan M. Advantages of early intervention with arterial embolization for intra-abdominal solid organ injuries in children. Diagn Interv Radiol 2019; 25:310-319. [PMID: 31199287 PMCID: PMC6622444 DOI: 10.5152/dir.2019.18559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Active bleeding due to abdominal trauma is an important cause of mortality in childhood. The aim of this study is to demonstrate the advantages of early percutaneous transcatheter arterial embolization (PTAE) procedures in children with intra-abdominal hemorrhage due to blunt trauma. METHODS Children with blunt abdominal trauma were retrospectively included. Two groups were identified for inclusion: patients with early embolization (EE group, n=10) and patients with late embolization (LE group, n=11). Both groups were investigated retrospectively and statistically analyzed with regard to lengths of stay in the intensive care unit and in the hospital, first enteral feeding after trauma, blood transfusion requirements, and cost. RESULTS The duration of stay in the intensive care unit was greater in the LE group than in the EE group (4 days vs. 2 days, respectively). The duration of hospital stay was greater in the LE group than in the EE group (14 days vs. 6 days, respectively). Blood transfusion requirements (15 cc/kg of RBC packs) were greater in the LE group than in the EE group (3 vs. 1, respectively). The total hospital cost was higher in the LE group than in the EE group (4502 USD vs. 1371.5 USD, respectively). The time before starting enteral feeding after first admission was higher in the LE group than in the EE group (4 days vs. 1 day, respectively). CONCLUSION Early embolization with PTAE results in shorter intensive care and hospitalization stays, earlier enteral feeding, and lower hospital costs for pediatric patients with intra-abdominal hemorrhage due to blunt trauma.
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Affiliation(s)
- Kubilay Gürünlüoğlu
- From the Departments of Pediatric Surgery (K.G., M.D. ), Radiology (İ.O.Y., R.K., K.S., A.S.) and Biostatistics and Medical Informatics (H.G.B.), İnönü University School of Medicine, Malatya, Turkey
| | - İsmail Okan Yıldırım
- From the Departments of Pediatric Surgery (K.G., M.D. ), Radiology (İ.O.Y., R.K., K.S., A.S.) and Biostatistics and Medical Informatics (H.G.B.), İnönü University School of Medicine, Malatya, Turkey
| | - Ramazan Kutlu
- From the Departments of Pediatric Surgery (K.G., M.D. ), Radiology (İ.O.Y., R.K., K.S., A.S.) and Biostatistics and Medical Informatics (H.G.B.), İnönü University School of Medicine, Malatya, Turkey
| | - Kaya Saraç
- From the Departments of Pediatric Surgery (K.G., M.D. ), Radiology (İ.O.Y., R.K., K.S., A.S.) and Biostatistics and Medical Informatics (H.G.B.), İnönü University School of Medicine, Malatya, Turkey
| | - Ahmet Sığırcı
- From the Departments of Pediatric Surgery (K.G., M.D. ), Radiology (İ.O.Y., R.K., K.S., A.S.) and Biostatistics and Medical Informatics (H.G.B.), İnönü University School of Medicine, Malatya, Turkey
| | - Harika Gözükara Bağ
- From the Departments of Pediatric Surgery (K.G., M.D. ), Radiology (İ.O.Y., R.K., K.S., A.S.) and Biostatistics and Medical Informatics (H.G.B.), İnönü University School of Medicine, Malatya, Turkey
| | - Mehmet Demircan
- From the Departments of Pediatric Surgery (K.G., M.D. ), Radiology (İ.O.Y., R.K., K.S., A.S.) and Biostatistics and Medical Informatics (H.G.B.), İnönü University School of Medicine, Malatya, Turkey
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24
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Vossoughi S, Gorlin J, Kessler DA, Hillyer CD, Van Buren NL, Jimenez A, Shaz BH. Ten years of TRALI mitigation: measuring our progress. Transfusion 2019; 59:2567-2574. [PMID: 31145481 DOI: 10.1111/trf.15387] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) is a leading cause of transfusion-associated mortality for which multiple mitigation strategies have been implemented over the past decade. However, product-specific TRALI rates have not been reported longitudinally and may help refine additional mitigation strategies. STUDY DESIGN AND METHODS This retrospective multicenter study included analysis of TRALI rates from 2007 through 2017. Numerators included definite or probable TRALI reports from five blood centers serving nine states in the United States. Denominators were components distributed from participating centers. Rates were calculated as per 100,000 components distributed (p < 0.05 significant). RESULTS One hundred four TRALI cases were reported from 10,012,707 components distributed (TRALI rate of 1.04 per 100,000 components). The TRALI rate was 2.25 for female versus 1.08 for male donated components (p < .001). The TRALI rate declined from 2.88 in 2007 to 0.60 in 2017. From 2007 to 2013, there was a significantly higher TRALI rate associated with female versus male plasma (33.85 vs. 1.59; p < 0.001) and RBCs (1.97 vs. 1.15; p = 0.03). From 2014 through 2017, after implementation of mitigation strategies, a significantly higher TRALI rate only from female-donated plateletpheresis continued to be observed (2.98 vs. 0.75; p = 0.04). CONCLUSION Although the TRALI rates have substantially decreased secondary to multiple strategies over the past decade, a residual risk remains, particularly with female-donated plateletpheresis products. Additional tools that may further mitigate TRALI incidence include the use of buffy coat pooled platelets suspended in male donor plasma or platelet additive solution due to the lower amounts of residual plasma.
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Affiliation(s)
- Sarah Vossoughi
- New York Blood Center, New York, New York.,Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
| | - Jed Gorlin
- Innovative Blood Resources, St. Paul, Minnesota
| | | | | | | | | | - Beth H Shaz
- New York Blood Center, New York, New York.,Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York
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25
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Osteopontin mediates murine transfusion-related acute lung injury via stimulation of pulmonary neutrophil accumulation. Blood 2019; 134:74-84. [PMID: 31076444 DOI: 10.1182/blood.2019000972] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/02/2019] [Indexed: 01/18/2023] Open
Abstract
Transfusion-related acute lung injury (TRALI) is one of the leading causes of transfusion-related fatalities and is characterized by the onset of acute respiratory distress within 6 hours upon blood transfusion. Specific therapies are unavailable. Preexisting inflammation is a risk factor for TRALI and neutrophils (polymorphonuclear neutrophils [PMNs]) are considered to be the major pathogenic cells. Osteopontin (OPN) is a multifunctional protein expressed at sites of inflammation and, for example, is involved in pulmonary disorders, can regulate cellular migration, and can function as a PMN chemoattractant. We investigated whether OPN is involved in TRALI induction by promoting PMN recruitment to the lungs. Using a previously established murine TRALI model, we found that in contrast to wild-type (WT) mice, OPN knockout (KO) mice were resistant to antibody-mediated PMN-dependent TRALI induction. Administration of purified OPN to the OPN KO mice, however, restored the TRALI response and pulmonary PMN accumulation. Alternatively, blockade of OPN in WT mice using an anti-OPN antibody prevented the onset of TRALI induction. Using pulmonary immunohistochemistry, OPN could be specifically detected in the lungs of mice that suffered from TRALI. The OPN-mediated TRALI response seemed dependent on macrophages, likely the cellular source of OPN and OPN polymerization, and independent from the OPN receptor CD44, interleukin 6 (IL-6), and other PMN chemoattractants including macrophage inflammatory protein-2 (MIP-2). These data indicate that OPN is critically required for induction of antibody-mediated murine TRALI through localization to the lungs and stimulation of pulmonary PMN recruitment. This suggests that anti-OPN antibody therapy may be a potential therapeutic strategy to explore in TRALI patients.
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26
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Vlaar APJ, Toy P, Fung M, Looney MR, Juffermans NP, Bux J, Bolton-Maggs P, Peters AL, Silliman CC, Kor DJ, Kleinman S. A consensus redefinition of transfusion-related acute lung injury. Transfusion 2019; 59:2465-2476. [PMID: 30993745 PMCID: PMC6850655 DOI: 10.1111/trf.15311] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/16/2019] [Accepted: 03/18/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) is a serious complication of blood transfusion and is among the leading causes of transfusion-related morbidity and mortality in most developed countries. In the past decade, the pathophysiology of this potentially life-threatening syndrome has been increasingly elucidated, large cohort studies have identified associated patient conditions and transfusion risk factors, and preventive strategies have been successfully implemented. These new insights provide a rationale for updating the 2004 consensus definition of TRALI. STUDY DESIGN AND METHODS An international expert panel used the Delphi methodology to develop a redefinition of TRALI by modifying and updating the 2004 definition. Additionally, the panel reviewed issues related to TRALI nomenclature, patient conditions associated with acute respiratory distress syndrome (ARDS) and TRALI, TRALI pathophysiology, and standardization of reporting of TRALI cases. RESULTS In the redefinition, the term "possible TRALI" has been dropped. The terminology of TRALI Type I (without an ARDS risk factor) and TRALI Type II (with an ARDS risk factor or with mild existing ARDS) is proposed. Cases with an ARDS risk factor that meet ARDS diagnostic criteria and where respiratory deterioration over the 12 hours before transfusion implicates the risk factor as causative should be classified as ARDS. TRALI remains a clinical diagnosis and does not require detection of cognate white blood cell antibodies. CONCLUSIONS Clinicians should report all cases of posttransfusion pulmonary edema to the transfusion service so that further investigation can allow for classification of such cases as TRALI (Type I or Type II), ARDS, transfusion-associated circulatory overload (TACO), or TRALI or TACO cannot distinguish or an alternate diagnosis.
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Affiliation(s)
- Alexander P J Vlaar
- Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Academic Medical Center, Amsterdam, the Netherlands
| | - Pearl Toy
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California
| | - Mark Fung
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont
| | - Mark R Looney
- Departments of Medicine and Laboratory Medicine, University of California at San Francisco, San Francisco, California
| | - Nicole P Juffermans
- Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Academic Medical Center, Amsterdam, the Netherlands
| | - Juergen Bux
- Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Paula Bolton-Maggs
- Serious Hazards of Transfusion Office, Manchester Blood Centre, Manchester, United Kingdom
| | - Anna L Peters
- Division Vital Functions, Department of Anesthesiology, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Christopher C Silliman
- School of Medicine, Pediatrics and Surgery, University of Colorado Denver, Denver, Colorado
| | - Daryl J Kor
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Steve Kleinman
- Department of Pathology, University British Columbia, Vancouver, British Columbia, Canada
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Perioperative Fluid Strategies to Prevent Lung Injury. Int Anesthesiol Clin 2019; 56:107-117. [PMID: 29189438 DOI: 10.1097/aia.0000000000000171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Transfusion-associated circulatory overload and transfusion-related acute lung injury. Blood 2019; 133:1840-1853. [PMID: 30808638 DOI: 10.1182/blood-2018-10-860809] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/10/2018] [Indexed: 01/18/2023] Open
Abstract
Transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI) are syndromes of acute respiratory distress that occur within 6 hours of blood transfusion. TACO and TRALI are the leading causes of transfusion-related fatalities, and specific therapies are unavailable. Diagnostically, it remains very challenging to distinguish TACO and TRALI from underlying causes of lung injury and/or fluid overload as well as from each other. TACO is characterized by pulmonary hydrostatic (cardiogenic) edema, whereas TRALI presents as pulmonary permeability edema (noncardiogenic). The pathophysiology of both syndromes is complex and incompletely understood. A 2-hit model is generally assumed to underlie TACO and TRALI disease pathology, where the first hit represents the clinical condition of the patient and the second hit is conveyed by the transfusion product. In TACO, cardiac or renal impairment and positive fluid balance appear first hits, whereas suboptimal fluid management or other components in the transfused product may enable the second hit. Remarkably, other factors beyond volume play a role in TACO. In TRALI, the first hit can, for example, be represented by inflammation, whereas the second hit is assumed to be caused by antileukocyte antibodies or biological response modifiers (eg, lipids). In this review, we provide an up-to-date overview of TACO and TRALI regarding clinical definitions, diagnostic strategies, pathophysiological mechanisms, and potential therapies. More research is required to better understand TACO and TRALI pathophysiology, and more biomarker studies are warranted. Collectively, this may result in improved diagnostics and development of therapeutic approaches for these life-threatening transfusion reactions.
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Tariket S, Hamzeh-Cognasse H, Arthaud CA, Laradi S, Bourlet T, Berthelot P, Garraud O, Cognasse F. Inhibition of the CD40/CD40L complex protects mice against ALI-induced pancreas degradation. Transfusion 2019; 59:1090-1101. [DOI: 10.1111/trf.15206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/18/2018] [Accepted: 11/19/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Sofiane Tariket
- Université de Lyon; GIMAP-EA3064; Saint-Etienne France
- Établissement Français du Sang Auvergne-Rhône-Alpes; Saint-Etienne France
| | | | | | - Sandrine Laradi
- Université de Lyon; GIMAP-EA3064; Saint-Etienne France
- Établissement Français du Sang Auvergne-Rhône-Alpes; Saint-Etienne France
| | | | | | - Olivier Garraud
- Université de Lyon; GIMAP-EA3064; Saint-Etienne France
- Institut National de Transfusion Sanguine (INTS); Paris France
| | - Fabrice Cognasse
- Université de Lyon; GIMAP-EA3064; Saint-Etienne France
- Établissement Français du Sang Auvergne-Rhône-Alpes; Saint-Etienne France
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Abstract
One of the defining features of acute respiratory distress syndrome (ARDS) is noncardiogenic pulmonary edema, resulting from increased permeability of the alveolar-capillary barrier and passage of protein-rich fluid into the interstitium and alveolar spaces. The loss of protein from the intravascular space disrupts the normal oncotic pressure differential and causes patients with ARDS to be particularly sensitive to the hydrostatic forces that correlate with intravascular volume. Conservative fluid management, in which diuretics are administered and intravenous fluid administration is minimized, may decrease hydrostatic pressure and increase serum oncotic pressure, potentially limiting the development of pulmonary edema. However, the cause of death in most patients with ARDS is multiorgan system failure, not hypoxemia, and the impact of conservative fluid management on the incidence of extrapulmonary organ failure during ARDS is unclear. These physiologic observations have led to a series of studies examining the impact of fluid management on the development of, resolution of, survival from, and long-term outcomes from ARDS. While questions remain, the current literature makes it clear that fluid management is an integral part of the care of patients with ARDS.
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Affiliation(s)
- Jonathan D. Casey
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Matthew W. Semler
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Todd W. Rice
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
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Blood loss mitigation and replacement in facial surgery: a review. Curr Opin Otolaryngol Head Neck Surg 2018; 26:266-274. [PMID: 29846240 DOI: 10.1097/moo.0000000000000461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW To provide a comprehensive overview of the predisposing factors that contribute to a risk of excess bleeding for surgical therapy in the head and neck regions, provide a thorough overview of techniques and tools for managing blood loss complications, and provide intervention algorithms to help guide clinical decision making. RECENT FINDINGS With the current landscape of medications and reversal agents, protocols for intervention in a variety of situations, and new tools for blood loss management all rapidly changing and being developed it is critical to stay up to date to provide patients the best care in the most critical of situations. SUMMARY With the risk of blood loss complications in head and neck surgery ranging from minimal to extreme surgeons require a comprehensive understanding risk factors, patient evaluation tools, and proper management algorithms. The first opportunity to prevent unnecessary blood loss and blood loss complications is the health history and physical appointment where a clinician can identify any medications, conditions, or other predisposing factors that would elevate a patient's risk of excess bleeding and the necessity for treatment augmentation. Although not all complications can be prevented because of the natural physiological variation that occurs from patient to patient, despite proper and proper diagnostics, a full working knowledge of most likely complications, hemostatic tools, and concise communication with team members can prevent a lot of blood loss and the complications associated.
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He R, Li L, Kong Y, Tian L, Tian X, Fang P, Bian M, Liu Z. Preventing murine transfusion-related acute lung injury by expansion of CD4 + CD25 + FoxP3 + Tregs using IL-2/anti-IL-2 complexes. Transfusion 2018; 59:534-544. [PMID: 30499590 DOI: 10.1111/trf.15064] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/12/2018] [Accepted: 10/12/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) is one of the most serious adverse events following transfusion, and there is no specific treatment in clinical practice. However, regulatory T cells (Tregs) have been suggested to play a potential role in the treatment of TRALI. This study investigated whether interleukin (IL)-2 or IL-2/anti-IL-2 complexes (IL-2c), which are mediators of Treg expansion, can modulate the severity of antibody-mediated TRALI in vivo. STUDY DESIGN AND METHODS This study utilized a mouse model of the "two-hit" mechanism: BALB/c mice were primed with lipopolysaccharide (LPS) as the first hit, and then TRALI was induced by injecting major histocompatibility complex Class I antibodies. Mice injected with LPS only or LPS combined with isotype control antibodies served as controls. For the Treg-depleted groups, mice were infused with anti-mouse IL-2Rα first and then subjected to the same treatments as the TRALI group. Regarding IL-2- and IL-2c-treated mice, recombinant murine IL-2 or IL-2c was intraperitoneally administered to mice for 5 consecutive days before induction of the TRALI model. Samples were collected 2 hours after TRALI induction. RESULTS Prophylactic administration of IL-2 or IL-2c to mice prevented the onset of edema, pulmonary protein levels, and proinflammatory factors that inhibited polymorphonuclear neutrophil aggregation in the lungs. Furthermore, the percentage of CD4+ CD25+ FoxP3+ Tregs was expanded in vivo using IL-2 and IL-2c compared to TRALI mice, as was confirmed through analysis of the spleen, blood, and lung. CONCLUSION This study validates that the protective mechanisms against TRALI involve CD4+ CD25+ FoxP3+ Tregs, which can be expanded in vivo by IL-2 and IL-2c. This results in increased IL-10 levels and decreased IL-17A, thereby prophylactically preventing antibody-mediated murine TRALI.
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Affiliation(s)
- Rui He
- Department of Blood Transfusion, First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Ling Li
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Yujie Kong
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Li Tian
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xue Tian
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
| | - Peng Fang
- Department of Blood Transfusion, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Maohong Bian
- Department of Blood Transfusion, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhong Liu
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, China
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Yasui K, Matsuyama N, Kimura T, Fujimura Y, Hirayama F. Immunoglobulin (Ig)G antibodies against IgE identified by basophil activation test as the putative causative agent of a serious allergic transfusion reaction: potential utility of the test as a new safety measure for allergic transfusion reactions. Transfusion 2018; 58:2572-2580. [PMID: 30264399 DOI: 10.1111/trf.14878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/05/2018] [Accepted: 06/18/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND In most cases of allergic transfusion reactions (ATRs), the causative agents have not been identified and the mechanisms are largely unknown, with a few exceptions. The basophil activation test (BAT) was recently introduced in the field of transfusion to investigate the causal relationships between ATRs and transfusion, as well as the mechanisms behind them. STUDY DESIGN AND METHODS The BAT was used to screen the residual supernatants (SNs) of 43 blood components associated with serious ATRs for those that can activate basophils of many healthy volunteers. The SNs were then fractionated by centrifugal ultrafiltration and protein G column chromatography and each separated fraction was reexamined by the BAT. RESULTS Of the 43 such blood components, one activated basophils from 19 of 21 healthy volunteers. In the blood component, the IgG antibody against IgE was identified as a putative causative agent. CONCLUSION Blood donors who possessed the IgG antibody against IgE may be dangerous to transfusion recipients. The BAT would be useful in identifying such high-risk blood donors, when it is used to screen the blood components associated with serious ATRs for residual SNs that can activate the basophils of many healthy volunteers.
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Affiliation(s)
- Kazuta Yasui
- Japanese Red Cross Kinki Block Blood Center, Ibaraki, Osaka, Japan
| | - Nobuki Matsuyama
- Japanese Red Cross Kinki Block Blood Center, Ibaraki, Osaka, Japan
| | - Takafumi Kimura
- Japanese Red Cross Kinki Block Blood Center, Ibaraki, Osaka, Japan
| | | | - Fumiya Hirayama
- Japanese Red Cross Kinki Block Blood Center, Ibaraki, Osaka, Japan
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35
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Loi MM, Kelher M, Dzieciatkowska M, Hansen KC, Banerjee A, West FB, Stanley C, Briel M, Silliman CC. A comparison of different methods of red blood cell leukoreduction and additive solutions on the accumulation of neutrophil-priming activity during storage. Transfusion 2018; 58:2003-2012. [PMID: 30171813 DOI: 10.1111/trf.14788] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 02/21/2018] [Accepted: 03/15/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Three methods of leukoreduction (LR) are used worldwide: filtration, buffy coat removal (BCR), and a combination of the previous two methods. Additionally, there are a number of additive solutions (ASs) used to preserve red blood cell (RBC) function throughout storage. During RBC storage, proinflammatory activity accumulates; thus, we hypothesize that both the method of LR and the AS affect the accumulation of proinflammatory activity. STUDY DESIGN AND METHODS Ten units of whole blood were drawn from healthy donors, the RBC units were isolated, divided in half by weight, and leukoreduced by: 1) BCR, 2) filtration, or 3) BCR and filtration (combination-LR); stored in bags containing AS-3 per AABB criteria; and sampled weekly. The supernatants were isolated and frozen (-80°C). RBC units drawn from healthy donors into AS-1-, AS-3-, or AS-5-containing bags were also stored and sampled weekly, and the supernatants were isolated and frozen. The supernatants were assayed for neutrophil (PMN)-priming activity and underwent proteomic analyses. RESULTS Filtration and combination LR decreased priming activity accumulation versus buffy coat LR, although the accumulation of priming activity was not different during storage. Combination LR increased hemolysis versus filtration via proteomic analysis. Priming activity from AS-3 units was significant later in storage versus AS-1- or AS-5-stored units. CONCLUSIONS Although both filtration and combination LR decrease the accumulation of proinflammatory activity versus buffy coat LR, combination LR is not more advantageous over filtration, has increased costs, and may cause increased hemolysis. In addition, AS-3 decreases the early accumulation of PMN-priming activity during storage versus AS-1 or AS-5.
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Affiliation(s)
- Michele M Loi
- Department of Research Laboratory, University of Colorado Denver, Aurora, Colorado.,Department of Pediatrics, University of Colorado Denver, Aurora, Colorado
| | - Marguerite Kelher
- Department of Research Laboratory, University of Colorado Denver, Aurora, Colorado.,Department of Surgery, University of Colorado Denver, Aurora, Colorado
| | - Monika Dzieciatkowska
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver, Aurora, Colorado
| | - Kirk C Hansen
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver, Aurora, Colorado
| | - Anirban Banerjee
- Department of Surgery, University of Colorado Denver, Aurora, Colorado
| | - F Bernadette West
- Connecticut, Mid-Atlantic, and Appalachian Regions, American Red Cross, Hartford, Connecticut
| | | | - Matthew Briel
- Manufacturing, Bonfils Blood Center, Denver, Colorado
| | - Christopher C Silliman
- Department of Research Laboratory, University of Colorado Denver, Aurora, Colorado.,Department of Pediatrics, University of Colorado Denver, Aurora, Colorado.,Department of Surgery, University of Colorado Denver, Aurora, Colorado
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36
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Ahmad M, Mathew J, Iqbal U, Tariq R. Strategies to avoid empiric blood product administration in liver transplant surgery. Saudi J Anaesth 2018; 12:450-456. [PMID: 30100846 PMCID: PMC6044145 DOI: 10.4103/sja.sja_712_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Massive blood loss has been a dreaded complication of liver transplantation, and the accompanying transfusion is associated with adverse outcomes in the form of decreased patient and graft survival. With advances in both surgical techniques and anesthetic management during transplantation, blood and blood products requirements reduced significantly. However, transfusion practices vary among different centers. The altered coagulation parameters in patients with liver cirrhosis results in a state of “rebalanced hemostasis” and patients are just as likely to clot as they are to bleed. Commonly used coagulation tests do not always reflect this new state and can, therefore, be misleading. Transfusion of blood products solely to correct abnormal parameters may worsen the coagulation status, thus adversely affecting patient outcome. Point-of-care tests such as thromboelastometry more reliably predict the risk of bleeding in these patients and in addition may provide quicker turnaround times compared to routine tests. Perioperative management should also include the possibility of thrombosis in these patients, and the use of low-molecular-weight heparin correlates with better patient survival. This review article aims to highlight the concept of rebalanced hemostasis, limitation of routine coagulation tests, and harmful effect of empiric transfusion of blood products.
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Affiliation(s)
- Mian Ahmad
- Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA 19102, USA
| | - Johann Mathew
- Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA 19102, USA
| | - Usama Iqbal
- Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA 19102, USA
| | - Rayhan Tariq
- Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia, PA 19102, USA
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Schreiber A, Yıldırım F, Ferrari G, Antonelli A, Delis PB, Gündüz M, Karcz M, Papadakos P, Cosentini R, Dikmen Y, Esquinas AM. Non-Invasive Mechanical Ventilation in Critically Ill Trauma Patients: A Systematic Review. Turk J Anaesthesiol Reanim 2018; 46:88-95. [PMID: 29744242 DOI: 10.5152/tjar.2018.46762] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 12/20/2017] [Indexed: 12/23/2022] Open
Abstract
There is limited literature on non-invasive mechanical ventilation (NIMV) in patients with polytrauma-related acute respiratory failure (ARF). Despite an increasing worldwide application, there is still scarce evidence of significant NIMV benefits in this specific setting, and no clear recommendations are provided. We performed a systematic review, and a search of clinical databases including MEDLINE and EMBASE was conducted from the beginning of 1990 until today. Although the benefits in reducing the intubation rate, morbidity and mortality are unclear, NIMV may be useful and does not appear to be associated with harm when applied in properly selected patients with moderate ARF at an earlier stage of injury by experienced teams and in appropriate settings under strict monitoring. In the presence of these criteria, NIMV is worth attempting, but only if endotracheal intubation is promptly available because non-responders to NIMV are burdened by an increased mortality when intubation is delayed.
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Affiliation(s)
- Annia Schreiber
- Fondazione Salvatore Maugeri, IRCCS, Respiratory Intensive Care Unit and Pulmonary Rehabilitation Unit, Pavia, Italy
| | - Fatma Yıldırım
- Ankara Dışkapı Yıldırım Beyazıt Research and Education Hospital, Intensive Care Unit, Ankara, Turkey
| | - Giovanni Ferrari
- Ospedale Mauriziano, Department of Respiratory Medicine, Turin Italy
| | - Andrea Antonelli
- Allergologia e Fisiopatologia Respiratoria, ASO S. Croce e Carle Cuneo, Cuneo, Italy
| | | | - Murat Gündüz
- Department of Anaesthesiology and Reanimation, Intensive Care Unit, Çukurova University School of Medicine, Adana, Turkey
| | - Marcin Karcz
- University of Rochester, Department of Anesthesiology, Critical Care Medicine, Rochester, New York, USA
| | - Peter Papadakos
- University of Rochester, Department of Anesthesiology, Surgery and Neurosurgery, Critical Care Medicine, Rochester, New York, USA
| | - Roberto Cosentini
- Emergency Medicine Department, Gruppo NIV, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Yalım Dikmen
- Department of Anaesthesiology and Reanimation, Intensive Care Unit, İstanbul University, Cerrahpaşa School of Medicine, İstanbul, Turkey
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A Comparison of Red Cell Rejuvenation versus Mechanical Washing for the Prevention of Transfusion-associated Organ Injury in Swine. Anesthesiology 2018; 128:375-385. [DOI: 10.1097/aln.0000000000001973] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Abstract
Background
We evaluated the effects of two interventions that modify the red cell storage lesion on kidney and lung injury in experimental models of transfusion.
Methods
White–landrace pigs (n = 32) were allocated to receive sham transfusion (crystalloid), 14-day stored allogeneic red cells, 14-day red cells washed using the red cells washing/salvage system (CATS; Fresenius, Germany), or 14-day red cells rejuvenated using the inosine solution (Rejuvesol solution; Zimmer Biomet, USA) and washed using the CATS device. Functional, biochemical, and histologic markers of organ injury were assessed for up to 24 h posttransfusion.
Results
Transfusion of 14 day red cells resulted in lung injury (lung injury score vs. sham, mean difference −0.3 (95% CI, −0.6 to −0.1; P = 0.02), pulmonary endothelial dysfunction, and tissue leukocyte sequestration. Mechanical washing reduced red cell–derived microvesicles but increased cell-free hemoglobin in 14-day red cell units. Transfusion of washed red cells reduced leukocyte sequestration but did not reduce the lung injury score (mean difference −0.2; 95% CI, −0.5 to 0.1; P = 0.19) relative to 14-day cells. Transfusion of washed red cells also increased endothelial activation and kidney injury. Rejuvenation restored adenosine triphosphate to that of fresh red cells and reduced microvesicle concentrations without increasing cell-free hemoglobin release. Transfusion of rejuvenated red cells reduced plasma cell-free hemoglobin, leukocyte sequestration, and endothelial dysfunction in recipients and reduced lung and kidney injury relative to 14-day or washed 14-day cells.
Conclusions
Reversal of the red cell storage lesion by rejuvenation reduces transfusion-associated organ injury in swine.
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Otrock ZK, Liu C, Grossman BJ. Transfusion-related acute lung injury risk mitigation: an update. Vox Sang 2017; 112:694-703. [PMID: 28948604 DOI: 10.1111/vox.12573] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 07/11/2017] [Accepted: 08/11/2017] [Indexed: 02/04/2023]
Abstract
Transfusion-related acute lung injury (TRALI) is a life-threatening complication of transfusion. Greater understanding of the pathophysiology of this syndrome has much improved during the last two decades. Plasma-containing components from female donors with leucocyte antibodies were responsible for the majority of TRALI fatalities before mitigation strategies were implemented. Over the past 15 years, measures to mitigate risk for TRALI have been implemented worldwide and they continued to evolve with time. The AABB requires that all plasma containing components and whole blood for transfusion must be collected from men, women who have not been pregnant, or women who have tested negative for human leucocyte antigen antibodies. Although the incidence of TRALI has decreased following the institution of TRALI mitigation strategies, TRALI is still the most common cause of transfusion-associated death in the United States. In this review, we focus on TRALI risk mitigation strategies. We describe the measures taken by blood collection facilities to reduce the risk of TRALI in the United States, Canada and European countries. We also review the literature for the effectiveness of these measures.
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Affiliation(s)
- Z K Otrock
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA
| | - C Liu
- Department of Pathology and Immunology, Barnes-Jewish Hospital, Washington University, St Louis, MO, USA
| | - B J Grossman
- Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA
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40
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Warner MA, Welsby IJ, Norris PJ, Silliman CC, Armour S, Wittwer ED, Santrach PJ, Meade LA, Liedl LM, Nieuwenkamp CM, Douthit B, van Buskirk CM, Schulte PJ, Carter RE, Kor DJ. Point-of-care washing of allogeneic red blood cells for the prevention of transfusion-related respiratory complications (WAR-PRC): a protocol for a multicenter randomised clinical trial in patients undergoing cardiac surgery. BMJ Open 2017; 7:e016398. [PMID: 28821525 PMCID: PMC5629697 DOI: 10.1136/bmjopen-2017-016398] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The transfusion-related respiratory complications, transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO), are leading causes of transfusion-related morbidity and mortality. At present, there are no effective preventive strategies with red blood cell (RBC) transfusion. Although mechanisms remain incompletely defined, soluble biological response modifiers (BRMs) within the RBC storage solution may play an important role. Point-of-care (POC) washing of allogeneic RBCs may remove these BRMs, thereby mitigating their impact on post-transfusion respiratory complications. METHODS AND ANALYSIS This is a multicenter randomised clinical trial of standard allogeneic versus washed allogeneic RBC transfusion for adult patients undergoing cardiac surgery testing the hypothesis that POC RBC washing is feasible, safe, and efficacious and will reduce recipient immune and physiologic responses associated with transfusion-related respiratory complications. Relevant clinical outcomes will also be assessed. This investigation will enrol 170 patients at two hospitals in the USA. Simon's two-stage design will be used to assess the feasibility of POC RBC washing. The primary safety outcomes will be assessed using Wilcoxon Rank-Sum tests for continuous variables and Pearson chi-square test for categorical variables. Standard mixed modelling practices will be employed to test for changes in biomarkers of lung injury following transfusion. Linear regression will assess relationships between randomised group and post-transfusion physiologic measures. ETHICS AND DISSEMINATION Safety oversight will be conducted under the direction of an independent Data and Safety Monitoring Board (DSMB). Approval of the protocol was obtained by the DSMB as well as the institutional review boards at each institution prior to enrolling the first study participant. This study aims to provide important information regarding the feasibility of POC washing of allogeneic RBCs and its potential impact on ameliorating post-transfusion respiratory complications. Additionally, it will inform the feasibility and scientific merit of pursuing a more definitive phase II/III clinical trial. REGISTRATION ClinicalTrials.gov registration number is NCT02094118 (Pre-results).
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Affiliation(s)
- Matthew A Warner
- Division of Critical Care, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Ian J Welsby
- Department of Anesthesiology, Duke University Medical Center, Raleigh, North Carolina, USA
| | - Phillip J Norris
- Blood Systems Research Institute,University of California, San Francisco, California, USA
| | | | - Sarah Armour
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Erica D Wittwer
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Paula J Santrach
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Laurie A Meade
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lavonne M Liedl
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Chelsea M Nieuwenkamp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian Douthit
- Department of Anesthesiology, Duke University Medical Center, Raleigh, North Carolina, USA
| | | | - Phillip J Schulte
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Rickey E Carter
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Daryl J Kor
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Morsing KSH, Peters AL, van Buul JD, Vlaar APJ. The role of endothelium in the onset of antibody-mediated TRALI. Blood Rev 2017; 32:1-7. [PMID: 28823763 DOI: 10.1016/j.blre.2017.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/14/2017] [Accepted: 08/04/2017] [Indexed: 12/11/2022]
Abstract
Transfusion Related Acute Lung Injury (TRALI) is one of the leading causes of mortality and morbidity following blood transfusion. The mechanisms behind the disease are not yet fully understood but seem to involve many different activating pathways and donor factors, in synergy with patient susceptibility. Studies have focused mostly on neutrophil activation, as aggregates of neutrophils and edema in lungs are found in post-mortem histological sections. This review aims to highlight the role of the endothelium in TRALI, as activated endothelium is the main promoter of leukocyte transmigration, and creates the barrier between blood and tissue. Since recent evidence suggests that a strong endothelial barrier prevents leukocyte transmigration and vascular leakage, we suggest that strengthening this barrier may be key to TRALI prevention.
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Affiliation(s)
- K S H Morsing
- Department of Plasma Proteins, Molecular Cell Biology Lab, Sanquin Research and Landsteiner Laboratory, Sanquin, Amsterdam, The Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands
| | - A L Peters
- Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - J D van Buul
- Department of Plasma Proteins, Molecular Cell Biology Lab, Sanquin Research and Landsteiner Laboratory, Sanquin, Amsterdam, The Netherlands
| | - A P J Vlaar
- Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands.
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42
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Khoy K, Nguyen MVC, Masson D, Bardy B, Drouet C, Paclet MH. Transfusion-related acute lung injury: critical neutrophil activation by anti-HLA-A2 antibodies for endothelial permeability. Transfusion 2017; 57:1699-1708. [PMID: 28608441 DOI: 10.1111/trf.14134] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 02/17/2017] [Accepted: 02/20/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) is a major complication of hemotherapy that may occur after the transfusion of any blood type component. Several clinical reports have suggested the presence of anti-HLA antibodies in the blood product. This study sought to examine the role of anti-HLA-A2 antibodies in polymorphonuclear neutrophil (PMN) activation and thus in endothelial permeability. STUDY DESIGN AND METHODS PMN activation was assessed by both nicotinamide adenine dinucleotide phosphate oxidase (NADPH oxidase) activity and reactive oxygen species (ROS) production. A coculture assay of EA.hy926 endothelial cells with PMNs or differentiated-PLB-985 cells, a model of neutrophil-like cells, was performed to estimate the impact of ROS on endothelial permeability. RESULTS Anti-HLA-A2 antibodies significantly increased PMN activation, with subsequent endothelial dysfunction. Phagocyte NADPH oxidase (NOX2) activity was shown to be involved in this process and ROS themselves were demonstrated to induce VE-cadherin cleavage and endothelial permeability. CONCLUSION Our data may support the existence of a critical anti-HLA-A2 antibody threshold for PMN activation, with NOX2 activity and subsequent endothelial permeability in the two-hit model of TRALI.
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Affiliation(s)
- Kathy Khoy
- GREPI EA 7408, Université Grenoble Alpes, Grenoble, France.,Université de Caen Normandie, CHU Caen, Caen, France
| | | | | | | | - Christian Drouet
- GREPI EA 7408, Université Grenoble Alpes, Grenoble, France.,CHU Grenoble Alpes, Grenoble, France
| | - Marie-Hélène Paclet
- GREPI EA 7408, Université Grenoble Alpes, Grenoble, France.,CHU Grenoble Alpes, Grenoble, France
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43
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The accumulation of lipids and proteins during red blood cell storage: the roles of leucoreduction and experimental filtration. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 15:131-136. [PMID: 28263170 DOI: 10.2450/2017.0314-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 12/20/2016] [Indexed: 02/06/2023]
Abstract
Pre-storage leucoreduction has been universally adopted in most developed countries in Asia, Europe and the Americas. It decreases febrile transfusion reactions, alloimmunisation to HLA antigens, cytomegalovirus exposure, the accumulation of a number of pro-inflammatory mediators in the supernatant, including the accumulation of platelet-and leucocyte-derived proteins and metabolites during routine storage. This review will highlight the lipids and proteins, biological response modifiers (BRMs) that accumulate, their clinical effects in transfused hosts, and methods of mitigation.
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44
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LaGrandeur RG, Tran M, Merchant C, Uy C. Transfusion-related acute lung injury following PDA ligation in a preterm neonate. J Neonatal Perinatal Med 2017; 10:339-342. [PMID: 28854506 DOI: 10.3233/npm-16107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Transfusion-related acute lung injury (TRALI) is a life-threatening complication of blood product transfusion characterized by sudden onset hypoxemic respiratory failure with bilateral lung infiltrates and non-cardiogenic pulmonary edema developing within 6 hours of transfusion. It is believed to be under-recognized, particularly among preterm neonates in whom co-existing developmental lung disease adds diagnostic complexity. Here we report the case of a preterm neonate who developed TRALI during a blood transfusion following PDA ligation.
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Affiliation(s)
- R G LaGrandeur
- Division of Neonatology, Department of Pediatrics, University of California Irvine Medical Center, Orange, CA, USA
| | - M Tran
- Department of Pathology, University of California Irvine Medical Center, Orange, CA, USA
| | - C Merchant
- Division of Neonatology, Department of Pediatrics, University of California Irvine Medical Center, Orange, CA, USA
| | - C Uy
- Division of Neonatology, Department of Pediatrics, University of California Irvine Medical Center, Orange, CA, USA
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45
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A Teenage Girl with Acute Dyspnea and Hypoxemia during Red Blood Cell Transfusion. Case Rep Pediatr 2016; 2016:9372678. [PMID: 27891282 PMCID: PMC5116353 DOI: 10.1155/2016/9372678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/20/2016] [Accepted: 10/18/2016] [Indexed: 11/20/2022] Open
Abstract
Transfusion-related acute lung injury (TRALI) can cause morbidity and mortality. We present the case of teenager who developed dyspnea and hypoxemia few hours after red cell transfusion. After being admitted for close monitoring and oxygen therapy, her symptoms spontaneously resolved. Message: dyspnea during red cell transfusion should raise the suspicion of TRALI.
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47
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Rong LQ, Di Franco A, Gaudino M. Acute respiratory distress syndrome after cardiac surgery. J Thorac Dis 2016; 8:E1177-E1186. [PMID: 27867583 DOI: 10.21037/jtd.2016.10.74] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Acute respiratory distress syndrome (ARDS) is a leading cause of postoperative respiratory failure, with a mortality rate approaching 40% in the general population and 80% in the subset of patients undergoing cardiac surgery. The increased risk of ARDS in these patients has traditionally been associated with the use of cardiopulmonary bypass (CPB), the need for blood product transfusions, large volume shifts, mechanical ventilation and direct surgical insult. Indeed, the impact of ARDS in the cardiac population is substantial, affecting not only survival but also in-hospital length of stay and long-term physical and psychological morbidity. No patient undergoing cardiac surgery can be considered ARDS risk-free. Early identification of those at higher risk is crucial to warrant the adoption of both surgical and non-surgical specific preventative strategies. The present review focuses on epidemiology, risk assessment, pathophysiology, prevention and management of ARDS in the specific setting of patients undergoing cardiac surgery.
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Affiliation(s)
- Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Antonino Di Franco
- Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Mario Gaudino
- Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY, USA
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48
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Peters AL, Vlaar AP. Redefining transfusion‐related acute lung injury: don't throw the baby out with the bathwater. Transfusion 2016; 56:2384-8. [DOI: 10.1111/trf.13643] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Anna L. Peters
- Laboratory of Experimental Intensive Care and Anaesthesia, Department of Intensive CareAcademic Medical CentreAmsterdam The Netherlands
| | - Alexander P.J. Vlaar
- Laboratory of Experimental Intensive Care and Anaesthesia, Department of Intensive CareAcademic Medical CentreAmsterdam The Netherlands
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49
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Abstract
The resuscitation of the injured patient continues to be a highly debated topic. Multiple studies have been performed with the intent to determine the optimal strategy to combat, and ultimately prevent, trauma induced coagulopathy. This chapter discusses the risks and benefits of resuscitation protocols utilizing plasma. Plasma is the aqueous portion of blood that contains coagulation factors, fibrinolytic proteins, albumin, immunoglobulins, and up to 6000 other proteins. Multiple methods of collection and storage have been developed, each one affecting the plasma and its proteins differently. Once collected, plasma can be frozen for storage. If frozen within 8 h, the product is labelled as fresh frozen plasma (FFP). If frozen more than 6 h, but less than 24 h, it is labelled as plasma frozen within 24 h (FP24). When FFP and FP24 are mobilized from the blood bank, they are thawed in a water bath to create thawed plasma (TP) which can be stored in liquid form for up to 4 days prior to transfusion. Liquid plasma (LQP) is derived from whole blood and is never frozen. It can be stored for up to 30 days by some reports prior to transfusion. Each of these forms of plasma has been extensively studied for efficacy of coagulation and are all useful in the resuscitation of a traumatically injured patient. There is much more than coagulation factors in plasma that are useful to patients. Studies looking at the endotheliopathy associated with hemorrhagic shock have shown a decrease in the inflammatory response, promotion of endothelial repair, and decreased edema. Transfusion protocols utilizing plasma at the time of presentation have shown a decrease in the amount of blood products transfused, as well as an improvement in mortality. Transfusion ratios of platelets–red blood cells–plasma units in a 1:1:1 ratio have shown a significant improvement in mortality at 3 h post-admission over 1:1:2. There has not been an increase in the incidence of adverse events with the increase usage of plasma. The early administration of plasma to the massively hemorrhaging traumatically injured patient improves mortality, decreases total blood product usage, and promotes the resolution of trauma induced endotheliopathy without increasing adverse events.
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Affiliation(s)
- Eduardo Gonzalez
- Dept of Surgery & Trauma Research Center, Univ of Colorado School of Medicine, Aurora, Colorado USA
| | - Hunter B. Moore
- Dept of Surgery & Trauma Research Center, Univ of Colorado School of Medicine, Aurora, Colorado USA
| | - Ernest E. Moore
- Dept of Surgery & Trauma Research Center, Univ of Colorado Sch of Med&Denver Healt, Denver, Colorado USA
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50
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van Stein D, Beckers EAM, Peters AL, Porcelijn L, Middelburg RA, Lardy NM, van Rhenen DJ, Vlaar APJ. Underdiagnosing of antibody-mediated transfusion-related acute lung injury: evaluation of cellular-based versus bead-based techniques. Vox Sang 2016; 111:71-8. [DOI: 10.1111/vox.12383] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 01/03/2016] [Accepted: 01/04/2016] [Indexed: 11/29/2022]
Affiliation(s)
- D. van Stein
- Department of Internal Medicine; Leiden University Medical Center; Leiden The Netherlands
| | - E. A. M. Beckers
- Department of Internal Medicine-Hematology; Maastricht University Medical Center; Maastricht The Netherlands
| | - A. L. Peters
- Department of Intensive Care Medicine; Academic Medical Center; Amsterdam The Netherlands
| | - L. Porcelijn
- Sanquin Diagnostics; Sanquin Blood Bank; Amsterdam The Netherlands
| | - R. A. Middelburg
- Center for clinical transfusion research; Sanquin Research; Leiden The Netherlands
- Department of Clinical Epidemiology; Leiden University Medical Center; Leiden The Netherlands
| | - N. M. Lardy
- Sanquin Diagnostics; Sanquin Blood Bank; Amsterdam The Netherlands
| | - D. J. van Rhenen
- South West Region; Sanquin Blood Bank; Rotterdam The Netherlands
| | - A. P. J. Vlaar
- Department of Intensive Care Medicine; Academic Medical Center; Amsterdam The Netherlands
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