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Liu S, Lin R, Zhang X, Lv Y, Zhu J, Chen G, Du Y. THE ALARMIN EFFECT OF HMGB1/RIP3 ON TRANSFUSION-RELATED ACUTE LUNG INJURY VIA TLR4/NF-ΚB OR MAPK PATHWAY. Shock 2023; 60:400-409. [PMID: 37477381 PMCID: PMC10510839 DOI: 10.1097/shk.0000000000002173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/31/2023] [Accepted: 06/21/2023] [Indexed: 07/22/2023]
Abstract
ABSTRACT Nonantibody-mediated transfusion-related acute lung injury (TRALI) may account for up to 25% of TRALI cases. This indicates the need for further research to understand the pathophysiological mechanisms involved beyond antibody mediation fully. During this research, a TRALI rat model was developed using the trauma-blood loss-massive transfusion method. The severity of pulmonary edema was checked via measurement of lung histopathological changes and the amount of Evans blue dye fluid and bronchoalveolar lavage fluid protein leakage. In addition, potential mechanisms of pathophysiological pathways and inflammation cascades were investigated in TRALI rats in vivo . The findings indicated that TRALI increased inflammatory cytokines and triggered elevated levels of high-mobility group box 1 (HMGB1)/receptor-interacting protein kinase 3 (RIP3), apoptosis protein, and mRNAs in the TM (TRALI model) group as opposed to the normal control. Furthermore, TRALI activated the toll-like receptor 4/nuclear factor kappa B and mitogen-activated protein kinase signaling pathways, which partially regulated the inflammatory response in the TRALI rats. A significant increase was observed in the inflammatory mediators HMGB1 and RIP3 during the early stages of TRALI, suggesting that these mediators could be used as diagnostic markers for TRALI. In addition, HMGB1 and RIP3 promoted the inflammatory response by stimulating the toll-like receptor 44/nuclear factor kappa B and mitogen-activated protein kinase signaling pathways in the lung tissue of rats. Identifying efficient agents from inflammatory mediators such as alarmin can be an innovative scheme for diagnosing and preventing TRALI. These findings give HMGB1 and RIP3 a strong theoretical and experimental foundation for clinical use.
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Affiliation(s)
- Shuangchun Liu
- Municipal Hospital Affiliated to Medical School of Taizhou University, Taizhou, China
| | - Ronghai Lin
- Municipal Hospital Affiliated to Medical School of Taizhou University, Taizhou, China
| | - Xianchao Zhang
- Municipal Hospital Affiliated to Medical School of Taizhou University, Taizhou, China
| | - Yinyi Lv
- Taizhou Central Hospital (Taizhou University Hospital), Taizhou University, Taizhou, China
| | - Jie Zhu
- Taizhou Central Hospital (Taizhou University Hospital), Taizhou University, Taizhou, China
| | - Guang Chen
- Taizhou Central Hospital (Taizhou University Hospital), Taizhou University, Taizhou, China
| | - Yunting Du
- Department of Laboratory Medicine, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
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2
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van Wonderen SF, Peters AL, Grey S, Rajbhandary S, de Jonge LL, Andrzejewski C, Narayan S, Wiersum-Osselton JC, Vlaar APJ. Standardized reporting of pulmonary transfusion complications: Development of a model reporting form and flowchart. Transfusion 2023. [PMID: 37060282 DOI: 10.1111/trf.17346] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Pulmonary complications of blood transfusion, including transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), and transfusion-associated dyspnea, are generally underdiagnosed and under-reported. The international TRALI and TACO definitions have recently been updated. Currently, no standardized pulmonary transfusion reaction reporting form exists and most of the hemovigilance forms have not yet incorporated the updated definitions. We developed a harmonized reporting form, aimed at improved data collection on pulmonary transfusion reactions for hemovigilance and research purposes by developing a standardized model reporting form and flowchart. MATERIALS AND METHODS Using a modified Delphi method among an international, multidisciplinary panel of 24 hemovigilance experts, detailed recommendations were developed for a standardized model reporting form for pulmonary complications of blood transfusion. Two Delphi rounds, including scoring systems, took place and several subsequent meetings were held to discuss issues and obtain consensus. Additionally, a flowchart was developed incorporating recently published redefinitions of pulmonary transfusion reactions. RESULTS In total, 17 participants completed the first questionnaire (70.8% response rate) and 14 participants completed the second questionnaire (58.3% response rate). According to the results from the questionnaires, the standardized model reporting form was divided into various subcategories: general information, patient history and transfusion characteristics, reaction details, investigations, treatment and supportive care, narrative, and transfused product. CONCLUSION In this article, we present the recommendations from a global group of experts in the hemovigilance field. The standardized model reporting form and flowchart provide an initiative that may improve data collected to address pulmonary transfusion reactions.
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Affiliation(s)
- Stefan F van Wonderen
- Department of Intensive Care, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Anna L Peters
- Division Vital Functions, Department of Anesthesiology, University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Sharran Grey
- Lancashire Haematology Centre, Blackpool Teaching Hospitals NHS Foundation Trust, North Lancashire, UK
| | - Srijana Rajbhandary
- Department of Research, Association for the Advancement of Blood and Biotherapies, Bethesda, Maryland, USA
| | - Layla L de Jonge
- TRIP (Transfusion and Transplantation Reactions in Patients) Hemovigilance and Biovigilance Office, Leiden, Netherlands
| | - Chester Andrzejewski
- Department of Pathology, Transfusion and Apheresis Medicine Services, Baystate Medical Center, Baystate Health, Springfield, Massachusetts, USA
| | - Shruthi Narayan
- Bristol Institute for Transfusion Sciences, National Health Service Blood and Transplant, Bristol, UK
| | - Johanna C Wiersum-Osselton
- TRIP (Transfusion and Transplantation Reactions in Patients) Hemovigilance and Biovigilance Office, Leiden, Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
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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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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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Bosboom JJ, Klanderman RB, Zijp M, Hollmann MW, Veelo DP, Binnekade JM, Geerts BF, Vlaar AP. Incidence, risk factors, and outcome of transfusion-associated circulatory overload in a mixed intensive care unit population: a nested case-control study. Transfusion 2017; 58:498-506. [DOI: 10.1111/trf.14432] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/03/2017] [Accepted: 10/20/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Joachim J. Bosboom
- Department of Anesthesiology; Academic Medical Centre; Amsterdam The Netherlands
| | - Robert B. Klanderman
- Laboratory of Experimental Intensive Care and Anesthesiology; Academic Medical Centre; Amsterdam The Netherlands
- Department of Intensive Care Medicine; Academic Medical Centre; Amsterdam The Netherlands
| | - Maarten Zijp
- Department of Anesthesiology; Academic Medical Centre; Amsterdam The Netherlands
| | - Markus W. Hollmann
- Department of Anesthesiology; Academic Medical Centre; Amsterdam The Netherlands
- Laboratory of Experimental Intensive Care and Anesthesiology; Academic Medical Centre; Amsterdam The Netherlands
| | - Denise P. Veelo
- Department of Anesthesiology; Academic Medical Centre; Amsterdam The Netherlands
| | - Jan M. Binnekade
- Department of Intensive Care Medicine; Academic Medical Centre; Amsterdam The Netherlands
| | - Bart F. Geerts
- Department of Anesthesiology; Academic Medical Centre; Amsterdam The Netherlands
| | - Alexander P.J. Vlaar
- Laboratory of Experimental Intensive Care and Anesthesiology; Academic Medical Centre; Amsterdam The Netherlands
- Department of Intensive Care Medicine; Academic Medical Centre; Amsterdam The Netherlands
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6
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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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7
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Reporting transfusion-related acute lung injury by clinical and preclinical disciplines. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 16:227-234. [PMID: 28488955 DOI: 10.2450/2017.0266-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 01/12/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Disciplines involved in diagnosing transfusion-related acute lung injury (TRALI) report according to a "one-hit" theory. However, studies showed that patients with an underlying condition are at increased risk of the development of TRALI. We investigated whether accumulating evidence on the "two-hit" theory has changed the practice of reporting TRALI. MATERIALS AND METHODS Departments of haematology, haemovigilance, transfusion medicine, intensive care and anaesthesiology from all Dutch hospitals with at least five beds equipped for mechanical ventilation were invited to participate in an online survey. Using clinical vignettes with conjoint analysis we investigated the effect of patients' age, admission diagnosis, type and number of transfusions and presence of risk factors for acute lung injury on TRALI reporting. A positive β-coefficient indicated a higher likelihood of reporting TRALI. RESULTS We received 129 questionnaires (response rate 74%). Respondents were more likely to report TRALI in younger patients, if symptoms developed within 2 hours of transfusion and if patients had received multiple transfusions. Sepsis and the presence of a risk factor for acute lung injury reduced the inclination to report. Transfusion medicine physicians and haemovigilance staff no longer took the age of transfusion products into account in their diagnostic considerations on TRALI. DISCUSSION We conclude that the multidisciplinary team involved in TRALI reporting, still considers TRALI a "one-hit" event, despite accumulating evidence that supports the "two-hit" theory. These results suggest that the patients most at risk of developing TRALI are not reported to the blood bank.
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8
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Hendrickson JE, Roubinian NH, Chowdhury D, Brambilla D, Murphy EL, Wu Y, Ness PM, Gehrie EA, Snyder EL, George Hauser R, Gottschall JL, Kleinman S, Kakaiya R, Strauss RG. Incidence of transfusion reactions: a multicenter study utilizing systematic active surveillance and expert adjudication. Transfusion 2016; 56:2587-2596. [PMID: 27460200 DOI: 10.1111/trf.13730] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 05/22/2016] [Accepted: 06/05/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Prevalence estimates of the serious hazards of transfusion vary widely. We hypothesized that the current reporting infrastructure in the United States fails to capture many transfusion reactions and undertook a multicenter study using active surveillance, data review, and adjudication to test this hypothesis. STUDY DESIGN AND METHODS A retrospective record review was completed for a random sample of 17% of all inpatient transfusion episodes over 6 months at four academic tertiary care hospitals, with an episode defined as all blood products released to a patient in 6 hours. Data were recorded by trained clinical research nurses, and serious reactions were adjudicated by a panel of transfusion medicine experts. RESULTS Of 4857 transfusion episodes investigated, 1.1% were associated with a serious reaction. Transfusion-associated circulatory overload was the most frequent serious reaction noted, being identified in 1% of transfusion episodes. Despite clinical notes describing a potential transfusion association in 59% of these cases, only 5.1% were reported to the transfusion service. Suspected transfusion-related acute lung injury/possible transfusion-related acute lung injury, anaphylactic, and hypotensive reactions were noted in 0.08, 0.02, and 0.02% of transfusion episodes, respectively. Minor reactions, including febrile nonhemolytic and allergic, were noted in 0.62 and 0.29% of transfusion episodes, respectively, with 30 and 50% reported to the transfusion service. CONCLUSION Underreporting of cardiopulmonary transfusion reactions is striking among academic, tertiary care hospitals. Complete and accurate reporting is essential to identify, define, establish pathogenesis, and mitigate/treat transfusion reactions. A better understanding of the failure to report may improve the accuracy of passive reporting systems.
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Affiliation(s)
- Jeanne E Hendrickson
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT. .,Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
| | - Nareg H Roubinian
- Department of Laboratory Medicine, University of California, San Francisco, CA.,Blood Systems Research Institute, San Francisco, California
| | | | | | - Edward L Murphy
- Department of Laboratory Medicine, University of California, San Francisco, CA.,Blood Systems Research Institute, San Francisco, California
| | - Yanyun Wu
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT.,Bloodworks Northwest, Seattle, Washington
| | - Paul M Ness
- Division of Transfusion Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric A Gehrie
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
| | - Edward L Snyder
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
| | - R George Hauser
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
| | - Jerome L Gottschall
- Blood Center of Wisconsin, Milwaukee, WI.,Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Steve Kleinman
- Center for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Ronald G Strauss
- The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
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9
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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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11
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Abstract
Three decades ago, transfusion-related acute lung injury (TRALI) was considered a rare complication of transfusion medicine. Nowadays, the US Food and Drug Administration acknowledge the syndrome as the leading cause of transfusion-related mortality. Understanding of the pathogenesis of TRALI has resulted in the design of preventive strategies from a blood-bank perspective. A major breakthrough in efforts to reduce the incidence of TRALI has been to exclude female donors of products with high plasma volume, resulting in a decrease of roughly two-thirds in incidence. However, this strategy has not completely eradicated the complication. In the past few years, research has identified patient-related risk factors for the onset of TRALI, which have empowered physicians to take an individualised approach to patients who need transfusion.
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Affiliation(s)
- Alexander P J Vlaar
- Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, Netherlands
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12
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Transfusion-related acute lung injury: Current understanding and preventive strategies. Transfus Clin Biol 2012; 19:117-24. [PMID: 22682310 DOI: 10.1016/j.tracli.2012.03.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 03/24/2012] [Indexed: 12/23/2022]
Abstract
Transfusion-related acute lung injury (TRALI) is the most serious complication of transfusion medicine. TRALI is defined as the onset of acute hypoxia within 6 hours of a blood transfusion in the absence of hydrostatic pulmonary oedema. The past decades have resulted in a better understanding of the pathogenesis of this potentially life-threating syndrome. The present notion is that the onset of TRALI follows a threshold model in which both patient and transfusion factors are essential. The transfusion factors can be divided into immune and non-immune mediated TRALI. Immune-mediated TRALI is caused by the passive transfer of human neutrophil antibodies (HNA) or human leukocyte antibodies (HLA) present in the blood product reacting with a matching antigen in the recipient. Non-immune mediated TRALI is caused by the transfusion of stored cell-containing blood products. Although the mechanisms behind immune-mediated TRALI are reasonably well understood, this is not the case for non-immune mediated TRALI. The increased understanding of pathways involved in the onset of immune-mediated TRALI has led to the design of preventive strategies. Preventive strategies are aimed at reducing the risk to exposure of HLA and HNA to the recipient of the transfusion. These strategies include exclusion of "at risk" donors and pooling of high plasma volume products and have shown to reduce the TRALI incidence effectively. This review discusses the current understanding of TRALI and preventive strategies available.
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Juffermans NP. Transfusion-related acute lung injury: emerging importance of host factors and implications for management. Expert Rev Hematol 2011; 3:459-67. [PMID: 21083036 DOI: 10.1586/ehm.10.41] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Recent insights from models of transfusion-related acute lung injury (TRALI), and from clinical reports, reveal that host factors are important in TRALI pathogenesis. Predisposing factors with lung neutrophil-priming capacity, such as sepsis and mechanical ventilation, increase susceptibility for a TRALI reaction, and can aggravate the course of disease. These findings may explain the higher incidence of TRALI in the critically ill compared with general hospital populations. The emerging importance of host factors may have implications for TRALI management. Suspected TRALI cases in which another acute lung injury risk factor is present (termed 'possible TRALI' in the consensus definition) should be reported to the blood bank, including patients suffering from an underlying condition. In reporting of TRALI cases, use of the international TRALI consensus definition should be used, rather then national TRALI scoring systems, to ensure a uniform approach, which may decrease variance in estimations of incidence. In terms of treatment of TRALI patients, there is a rationale to apply therapeutic strategies, which have proven to be beneficial in acute lung injury.
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Affiliation(s)
- Nicole P Juffermans
- Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Academic Medical Center, Room G3-206, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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14
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Ozier Y, Muller JY, Mertes PM, Renaudier P, Aguilon P, Canivet N, Fabrigli P, Rebibo D, Tazerout M, Trophilme C, Willaert B, Caldani C. Transfusion-related acute lung injury: reports to the French Hemovigilance Network 2007 through 2008. Transfusion 2011; 51:2102-10. [DOI: 10.1111/j.1537-2995.2011.03073.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Tuinman PR, Vlaar AP, Cornet AD, Hofstra JJ, Levi M, Meijers JCM, Beishuizen A, Schultz MJ, Groeneveld ABJ, Juffermans NP. Blood transfusion during cardiac surgery is associated with inflammation and coagulation in the lung: a case control study. Crit Care 2011; 15:R59. [PMID: 21314930 PMCID: PMC3221992 DOI: 10.1186/cc10032] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 01/18/2011] [Accepted: 02/11/2011] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Blood transfusion is associated with increased morbidity and mortality in cardiac surgery patients, but cause-and-effect relations remain unknown. We hypothesized that blood transfusion is associated with changes in pulmonary and systemic inflammation and coagulation occurring in patients who do not meet the clinical diagnosis of transfusion-related acute lung injury (TRALI). METHODS We performed a case control study in a mixed medical-surgical intensive care unit of a university hospital in the Netherlands. Cardiac surgery patients (n = 45) were grouped as follows: those who received no transfusion, those who received a restrictive transfusion (one two units of blood) or those who received multiple transfusions (at least five units of blood). Nondirected bronchoalveolar lavage fluid (BALF) and blood were obtained within 3 hours postoperatively. Normal distributed data were analyzed using analysis of variance and Dunnett's post hoc test. Nonparametric data were analyzed using the Kruskal-Wallis and Mann-Whitney U tests. RESULTS Restrictive transfusion increased BALF levels of interleukin (IL)-1β and D-dimer compared to nontransfused controls (P < 0.05 for all), and IL-1β levels were further enhanced by multiple transfusions (P < 0.01). BALF levels of IL-8, tumor necrosis factor α (TNFα) and thrombin-antithrombin complex (TATc) were increased after multiple transfusions (P < 0.01, P < 0.001 and P < 0.01, respectively) compared to nontransfused controls, but not after restrictive transfusions. Restrictive transfusions were associated with increased pulmonary levels of plasminogen activator inhibitor 1 compared to nontransfused controls with a further increase after multiple transfusions (P < 0.001). Concomitantly, levels of plasminogen activator activity (PAA%) were lower (P < 0.001), indicating impaired fibrinolysis. In the systemic compartment, transfusion was associated with a significant increase in levels of TNFα, TATc and PAA% (P < 0.05). CONCLUSIONS Transfusion during cardiac surgery is associated with activation of inflammation and coagulation in the pulmonary compartment of patients who do not meet TRALI criteria, an effect that was partly dose-dependent, suggesting transfusion as a mediator of acute lung injury. These pulmonary changes were accompanied by systemic derangement of coagulation.
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Affiliation(s)
- Pieter R Tuinman
- Department of Intensive Care Medicine and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Meibergdreef 9, Amsterdam, NL-1105 AZ, The Netherlands
| | - Alexander P Vlaar
- Department of Intensive Care Medicine and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Meibergdreef 9, Amsterdam, NL-1105 AZ, The Netherlands
| | - Alexander D Cornet
- Department of Intensive Care Medicine, VU University Medical Center, De Boelelaan 1117, Amsterdam, NL-1081 HZ, The Netherlands
| | - Jorrit J Hofstra
- Department of Intensive Care Medicine and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Meibergdreef 9, Amsterdam, NL-1105 AZ, The Netherlands
| | - Marcel Levi
- Department of Internal Medicine, Academic Medical Center, Meibergdreef 9, Amsterdam, NL-1105 AZ, The Netherlands
| | - Joost CM Meijers
- Department of Experimental Vascular Medicine, Academic Medical Center, Meibergdreef 9, Amsterdam, NL-1105 AZ, The Netherlands
| | - Albertus Beishuizen
- Department of Intensive Care Medicine, VU University Medical Center, De Boelelaan 1117, Amsterdam, NL-1081 HZ, The Netherlands
| | - Marcus J Schultz
- Department of Intensive Care Medicine and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Meibergdreef 9, Amsterdam, NL-1105 AZ, The Netherlands
| | - AB Johan Groeneveld
- Department of Intensive Care Medicine, VU University Medical Center, De Boelelaan 1117, Amsterdam, NL-1081 HZ, The Netherlands
| | - Nicole P Juffermans
- Department of Intensive Care Medicine and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Meibergdreef 9, Amsterdam, NL-1105 AZ, The Netherlands
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16
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Azoulay E. Pleuropulmonary Changes Induced by Drugs in Patients with Hematologic Diseases. PULMONARY INVOLVEMENT IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES 2011. [PMCID: PMC7123804 DOI: 10.1007/978-3-642-15742-4_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Patients with hematologic diseases who are being treated with therapy drugs, or receive radiation therapy or blood transfusions may develop a host of potentially fatal infectious and noninfectious pulmonary complications [1]. The increased complexity of multimodality and high-dose treatment regimens with the intended benefit of augmented antineoplastic efficacy and prolonged disease-free survival, the use of a panel of novel drugs to treat malignant and nonmalignant hematologic conditions (e.g., azacytidine, bortezomib, cladribine, dasatinib, fludarabine, imatinib, lenalidomide, rituximab, and thalidomide), total body irradiation (TBI) and hematopietic stem cell transplantation (HSCT) have increased the incidence of severe sometimes life-threatening pulmonary complications.
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Affiliation(s)
- Elie Azoulay
- Service de Réanimation Médicale, Hôpital Saint Louis, Avenue Claude Vellefaux 1, Paris, 75010 France
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17
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Wiersum-Osselton JC, Middelburg RA, Beckers EA, van Tilborgh AJ, Zijlker-Jansen PY, Brand A, van der Bom JG, Schipperus MR. Male-only fresh-frozen plasma for transfusion-related acute lung injury prevention: before-and-after comparative cohort study. Transfusion 2010; 51:1278-83. [DOI: 10.1111/j.1537-2995.2010.02969.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Cornet AD, Zwart E, Kingma SDK, Groeneveld ABJ. Pulmonary effects of red blood cell transfusion in critically ill, non-bleeding patients. Transfus Med 2010; 20:221-6. [PMID: 20230533 DOI: 10.1111/j.1365-3148.2010.01000.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of the study is to evaluate the effects of red blood cell (RBC) transfusions on pulmonary parameters in critically ill, non-bleeding patients. Retrospective chart analysis was performed on critically ill patients without overt bleeding in the intensive care unit (ICU) of a university hospital. In 83 patients in a 5-month period, who had received at least 1 RBC unit and stayed at least 24 h in the ICU, 199 transfusions of median 2 RBCs per transfusion (n = 504) were studied. Pulmonary parameters were retrieved during the period between 24 h before the start of transfusion and 24-48 h after transfusion. Outcome was assessed. The P(a)O(2)/F(I)O(2) dose-dependently decreased from 250 +/- 105 at baseline to 240 +/- 102 mmHg at 24 h after RBC transfusion (P = 0.003), irrespective of acute lung injury at baseline and RBC storage time. The lung injury score (LIS) also increased dose-dependently, whereas, at 48 h, oxygenation and LIS largely returned to baseline. For every seven RBCs transfused, the LIS transiently increased by 1 unit. There were no changes in haemodynamics, lung mechanics or chest radiography. The total number of RBCs given in the ICU did not directly contribute to ICU and 1-year mortality prediction. Transfusion of RBCs decreases oxygenation thereby increasing the LIS, dose-dependently and transiently, in a heterogeneous population of critically ill, non-bleeding patients, independent of prior cardiorespiratory status and RBC storage time. The effects are subtle, may go unseen and unreported and may represent subclinical transfusion-related acute lung injury. They do not adversely affect outcome, even at 1-year follow-up.
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Affiliation(s)
- A D Cornet
- Department of Intensive Care and Institute for Cardiovascular Research, Vrije Universiteit Medical Center, 1081 HV Amsterdam, The Netherlands
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19
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Vlaar APJ, Wolthuis EK, Hofstra JJ, Roelofs JJTH, Boon L, Schultz MJ, Lutter R, Juffermans NP. Mechanical ventilation aggravates transfusion-related acute lung injury induced by MHC-I class antibodies. Intensive Care Med 2010; 36:879-87. [PMID: 20221752 DOI: 10.1007/s00134-010-1802-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Accepted: 02/02/2010] [Indexed: 01/02/2023]
Abstract
PURPOSE Transfusion-related acute lung injury (TRALI) occurs more often in critically ill patients than in a general hospital population, possibly due to the presence of underlying inflammatory conditions that may prime pulmonary neutrophils. Mechanical ventilation may be a risk factor for developing TRALI. We examined the influence of mechanical ventilation (MV) on the development of TRALI, combining a murine MV model causing ventilator-induced lung injury with a model of antibody-induced TRALl. METHODS BALB/c mice (n = 84) were ventilated for 5 h with low (7.5 ml/kg) or high (15 ml/kg) tidal volume, a positive end-expiratory pressure of 2 cm H(2)O and a fraction of inspired oxygen of 50%. After 3 h of MV, TRALI was induced by infusion of MHC-I antibodies (4.5 mg/kg); controls received vehicle. Non-ventilated animals receiving vehicle, isotype or MHC-I antibodies served as additional controls. RESULTS All animals receiving MHC-I antibodies developed TRALI within 2 h. In mice in which TRALI was induced, MV with low tidal volumes aggravated pulmonary injury, as evidenced by an increase in neutrophil influx, pulmonary and systemic levels of cytokines and lung histopathological changes compared to unventilated controls. The use of high tidal volume ventilation resulted in a further increase in protein leakage and pulmonary edema. CONCLUSIONS Mechanical ventilation (MV) synergistically augmented lung injury during TRALI, which was even further enhanced by the use of injurious ventilator settings. Results suggest that MV may be a risk factor for the onset of TRALI and may aggravate the course of disease.
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Affiliation(s)
- A P J Vlaar
- Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands.
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