Conversion to low transfusion‐related acute lung injury (TRALI)‐risk plasma significantly reduces TRALI

Arinsburg, Suzanne; Skerrett, Donna; Karp, Julie Katz; Ness, Paul M.; Jhang, Jeffrey S.; Padmanabhan, Anand; Gibble, Joan; Schwartz, Joseph; King, Karen E.; Cushing, Melissa M.

doi:10.1111/j.1537-2995.2011.03403.x

Cited by 31 publications

(41 citation statements)

References 16 publications

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“…Since then, explicit criteria applied under study conditions have varied. 34,35 Furthermore, while some authors reported TRALI rates, 33,36 others grouped TRALI and possible TRALI 37 (as we did).…”

Section: Discussionsupporting

confidence: 56%

“…Not only has TRALI recognition improved, but there have also been changes in blood management and donor procurement strategies that may have reduced the rate of TRALI. 10,11,37 Although our study did not demonstrate this hypothesized decline in incidence after TRALI mitigation strategies were introduced (as discussed in the next paragraph of this Discussion), a substantial and growing body of medical literature supports this effect. 11,37 Consequently, we believe that early data before the mid-2000s are unlikely to be representative of the current syndrome burden.…”

Section: Discussionmentioning

confidence: 55%

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Characterizing the Epidemiology of Postoperative Transfusion-related Acute Lung Injury

et al. 2015

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Background Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related death in the United States; however, it remains poorly characterized in surgical populations. To better inform perioperative transfusion practice, and to help mitigate perioperative TRALI, the authors aimed to better define its epidemiology before and after TRALI mitigation strategies were introduced. Methods This retrospective cohort study examined outcomes of adult patients undergoing noncardiac surgery with general anesthesia who received intraoperative transfusions during 2004 (n = 1,817) and 2011 (n = 1,562). The demographics and clinical characteristics of transfusion recipients, blood transfusion descriptors, and combined TRALI/possible TRALI incidence rates were evaluated. Univariate analyses were used to compare associations between patient characteristics, transfusion details, and TRALI mitigation strategies with TRALI/possible TRALI incidence rates in a before-and-after study design. Results The incidence of TRALI/possible TRALI was 1.3% (23 of 1,613) in 2004 versus 1.4% (22 of 1,562) in 2011 (P = 0.72), with comparable overall rates in males versus females (1.4% [23 of 1,613] vs. 1.2% [22 of 1,766]) (P = 0.65). Overall, thoracic (3.0% [4 of 133]), vascular (2.7% [10 of 375]), and transplant surgeries (2.2% [4 of 178]) carried the highest rates of TRALI/possible TRALI. Obstetric and gynecologic surgical patients had no TRALI episodes. TRALI/possible TRALI incidence increased with larger volumes of blood product transfused (P < 0.001). Conclusions Perioperative TRALI/possible TRALI is more common than previously reported and its risk increases with greater volumes of blood component therapies. No significant reduction in the combined incidence of TRALI/possible TRALI occurred between 2004 and 2011, despite the introduction of TRALI mitigation strategies. Future efforts to identify specific risk factors for TRALI/possible TRALI in surgical populations may reduce the burden of this life-threatening complication.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 55%

Characterizing the Epidemiology of Postoperative Transfusion-related Acute Lung Injury

et al. 2015

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“…This technology has been used previously at our institution to develop screening algorithms for other critical care syndromes with great success. 15–17 …”

Section: Methodsmentioning

confidence: 99%

Characterizing the Epidemiology of Perioperative Transfusion-associated Circulatory Overload

et al. 2015

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Background Transfusion-associated circulatory overload (TACO) is a leading cause of transfusion-related fatalities, but its incidence and associated patient and transfusion characteristics are poorly understood. To inform surgical transfusion practice and to begin mitigating perioperative TACO, the authors aimed to define its epidemiology. Methods In this retrospective cohort study, the medical records of adult patients undergoing noncardiac surgery with general anesthesia during 2004 or 2011 and receiving intraoperative transfusions were screened using an electronic algorithm for identification of TACO. Those patients who were screened as high probability for TACO underwent rigorous manual review. Univariate and multivariate analyses evaluated associations between patient and transfusion characteristics with TACO rates in a before-and-after study design. Results A total of 2,162 and 1,908 patients met study criteria for 2004 and 2011, respectively. The incidence of TACO was 5.5% (119 of 2,162) in 2004 versus 3.0% (57 of 1,908) in 2011 (P < 0.001), with comparable rates for men (4.8% [98 of 2,023]) and women (3.8% [78 of 2,047]) (P = 0.09). Overall, vascular (12.1% [60 of 497]), transplant (8.8% [17 of 193]), and thoracic surgeries (7.2% [10 of 138]) carried the highest TACO rates. Obstetric and gynecologic patients had the lowest rate (1.4% [4 of 295]). The incidence of TACO increased with volume transfused, advancing age, and total intraoperative fluid balance (all P < 0.001). Conclusions The incidence of perioperative TACO is similar to previous estimates in nonsurgical populations. There was a reduction in TACO rate between 2004 and 2011, with incidence patterns remaining comparable in subgroup analyses. Future efforts exploring risk factors for TACO may guide preventive or therapeutic interventions, helping to further mitigate this transfusion complication.

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“…German and Canadian hemovigilance systems also showed a decrease in the number of reported TRALI cases, 73,74 and a comparative cohort study from the Netherlands showed a 33% reduction of TRALI cases after implementation of a male‐only plasma strategy 75 . A retrospective study in three US hospitals showed a 0.0084% risk of TRALI from plasma transfusion (47,756 plasma units transfused) in the 16 months preceding implementation of low‐TRALI‐risk plasma versus 0% risk in the 16 months after implementation (52,230 plasma units transfused) 76 . Finally, in the only large active surveillance study of TRALI, TRALI incidence went from 1:4000 blood products transfused before mitigation to 1:12,000 after mitigation 38 .…”

Section: Tralimentioning

confidence: 99%

Adverse effects of plasma transfusion

Pandey¹,

Vyas²

2012

Transfusion

302

251

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Plasma utilization has increased over the last two decades, and there is a growing concern that many plasma transfusions are inappropriate. Plasma transfusion is not without risk, and certain complications are more likely with plasma than other blood components. Clinical and laboratory investigations of the patients suffering reactions following infusion of fresh frozen plasma (FFP) define the etiology and pathogenesis of the panoply of adverse effects. We review here the pathogenesis, diagnosis, and management of the risks associated with plasma transfusion. Risks commonly associated with FFP include: (1) transfusion related acute lung injury; (2) transfusion associated circulatory overload, and (3) allergic/anaphylactic reactions. Other less common risks include (1) transmission of infections, (2) febrile non-hemolytic transfusion reactions, (3) RBC allo-immunization, and (4) hemolytic transfusion reactions. The affect of pathogen inactivation/reduction methods on these risks are also discussed. Fortunately, a majority of the adverse effects are not lethal and are adequately treated in clinical practice.

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Conversion to low transfusion‐related acute lung injury (TRALI)‐risk plasma significantly reduces TRALI

Abstract: The conversion to low-TRALI-risk plasma has reduced the incidence of TRALI reactions in plasma recipients.

Cited by 31 publications

References 16 publications

Characterizing the Epidemiology of Postoperative Transfusion-related Acute Lung Injury

Characterizing the Epidemiology of Postoperative Transfusion-related Acute Lung Injury

Characterizing the Epidemiology of Perioperative Transfusion-associated Circulatory Overload

Adverse effects of plasma transfusion

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