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Transfusion-related acute lung injury: TRALI : 

Transfusion-related acute lung injury: TRALI Moderator – Dr. Anil Verma Presented by- Mukesh Kumar

Introduction : 

Introduction TRALI: poorly understood, life-threatening complication of blood perfusion, complicated by acute lung injury (ALI), may progress to acute respiratory distress syndrome (ARDS) Finally definition: noncardiogenic pulmonary edema occuring during or within six hours of transfusion

Epidemiology : 

Epidemiology FDA(2004):the leading cause of transfusion-related death in the United States Mortality rate:5-8% Incidence: not well established Underrecognition and underreporting All plasma-containing blood and blood compartments 1/5,000 blood & blood component 1/2,000 plasma-containing component 1/7,900 units of FFP 1/432 units of whole blood derived platelets

Risk Factors : 

Risk Factors No definite risk factors for TRALI Implicated in some, not all: prolonged storage of blood products Platelate concentrate an underlying condition such as recent surgery Thrombocytopenia massive blood transfusion Acute infection Blood product from multiparous female

pathophysiology : 

pathophysiology 1.Antibody mediated reaction-between recipient granulocyte and antigranulocyte antibody from donor 2.Lipid product of cell degradation 3.Two hit mechanism- a.priming and adherance of neutrophil to pulmonary epithelium-1st hit may be – surgery,sepsis,trauma,massive blood transfusion,haematologic malignancy,chemotherapy

continue : 

continue 2nd hit- transfusion-----activation of primed neutrophil-------release of reactive oxygen species---------cappillary leak ------ pulmonary oedema

Clinical Presentation : 

Clinical Presentation Sudden onset, within 6 hours, but usually begin within 1~2 hours, of respiratory distress after transfusion

Clinical Presentation : 

Clinical Presentation CXR: bilateral patchy alveolar infiltrates, classically with a normal cardiac silhouette and without effusions, consistent with ARDS Resolution rapidly, even when initial hypoxemia is severe Most can be extubated within 48 hours CXR return to normal within four days, although hypoxemia and pulmonary infiltrates persist up to seven days in a minority of patients

Diagnosis : 

Diagnosis National Heart, Lung, and Blood Institute working group and Canadian consensus conference

D/D: think more before TRALI : 

D/D: think more before TRALI Transfusion- associated cardiac overload (TACO) 2.Transfusion mismatch 3.Myocardial infraction 4.Pulmonary embolism 5.anaphylaxis

LAB Diagnosis : 

LAB Diagnosis The finding of granulocyte, leukoagglutinating, or lymphocytotoxic antibodies in serum from either the donor or the recipient is strong support for the diagnosis of TRALI -> Decline in C3 or C5a levels 12 to 36 hours after the onset of symptoms, followed by a significant rise four to seven days later

Treatment : 

Treatment Stop tranfusion Send unused blood for rechek Make correct diagnosis- Mild form of TRALI- treated with supplement humidified oxygen inhalation Severe form treated- intravenous fluid -lung protective ventilation(low tidal volume with low plateau pressure ventilation) -vasopressors to maintain mean arterial pressure at 60 mm Hg

Subsequent use of blood products : 

Subsequent use of blood products The recipient No further plasma-containing blood products from the implicated donor No increased risk for recurrent episodes following transfusions from other donors

Thanks YOU for your attention! : 

Thanks YOU for your attention!

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