Association of massive transfusion for resuscitation in gastrointestinal bleeding with transfusion-related acute lung injury

Abstract

Background and Aims:This study aimed to understand the use of massive transfusion (MT) for gastrointestinal bleeding (GIB).Patients and Methods:We performed a retrospective analysis of patients admitted to our medical Intensive Care Unit (ICU) with GIB for the type of bleeding, quantity of blood products transfused, and risk of transfusion-related acute lung injury (TRALI) and death. MT was defined as transfusion of 10 or more units of red blood cell (RBC) within a 24-h period in a 1-unit RBC: 1-unit fresh frozen plasma: and 1-unit platelet ratio. TRALI was defined as development of acute lung injury (ALI), within 6 h of transfusion, with new bilateral pulmonary infiltrates, absence of circulatory overload, or other explanation for ALI.Results:In a 43-month interval, 169 patients were admitted to the ICU with GIB and received blood products, of whom 13 received MT. Ten patients developed TRALI, of whom 7 (70%) had received MT. MT was associated with an increased risk of TRALI (odds ratio [OR]: 17.9, 95% confidence interval [CI]: 2.9–111.2, P = 0.002) after adjusting for age, sex, body mass index, baseline vitals, and laboratory data. Death was predicted by MT (OR: 5.6, 95% CI: 1.6–19.7, P = 0.007), TRALI (OR: 2.3, 95% CI: 1.1–4.6, P = 0.02), and Acute Physiologic Chronic Health Evaluation II score (OR: 1.17 per unit increase, 95% CI: 1.09–1.26, P < 0.001) after adjusting for age and sex.Conclusions:MT for GIB is associated with an increased risk of TRALI and death. Prospective studies assessing the use of MT in this population are needed to understand and improve outcomes.

Cryopreservation alters the immune characteristics of platelets

“…Notably, IL‐1β, OX40L, IL‐13, IL‐27, and CD40L have previously been strongly associated with adverse reactions 20 . As such, a lower concentration of these particular mediators in the supernatant may be advantageous, particularly to minimize the risk of TRALI in critically injured patients undergoing massive transfusion 40 . However, other BRMs, including RANTES, are present in higher concentrations following thawing, which have also been linked to adverse events 20 .…”

“…20 As such, a lower concentration of these particular mediators in the supernatant may be advantageous, particularly to minimize the risk of TRALI in critically injured patients undergoing massive transfusion. 40 However, other BRMs, including RANTES, are present in higher concentrations following thawing, which have also been linked to adverse events. 20 Consequently, it remains difficult to speculate on the overall immunogenicity of the cryopreserved platelet component without the collection of further data from appropriately designed clinical studies.…”

Bleeding risk and thrombosis in cirrhosis: a paradox with a need to address them

“…To be more specific, the guideline indicates that in patients with cirrhosis undergoing invasive procedures (both low and high risk), correction of a prolonged INR with fresh frozen plasma (FFP) is not recommended to decrease the rate of procedure-related clinically relevant bleeding. This is relevant given the well-known harms of FFP infusion, which is associated with an increased risk of lung injury and allergic reactions, and transfusion-associated circulatory overload (TACO) ( 9 , 10 ). Avoiding the use of blood products, in addition, can reduce the costs associated with laboratory testing and the unnecessary use of blood products.…”