Pulmonary complications of transfusion: Changes, challenges, and future directions

Grey, Sharran

doi:10.1111/tme.12709

Cited by 6 publications

(7 citation statements)

References 26 publications

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“…Duration or rates of transfusions were not reported in the ETTNO and TOP trials. High-volume or high-rate transfusions may increase the risk of transfusion associated circulatory overload (TACO), a leading cause of transfusion-associated morbidity and mortality in adults 39. Neonatal TACO is poorly defined and the true incidence of this and other transfusion-related lung injuries in neonates is not known; observational studies have shown variable outcomes 37 40–42.…”

Section: Discussionmentioning

confidence: 99%

Survey of transfusion practices in preterm infants in Europe

Scrivens

Reibel

Heeger

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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BackgroundPreterm infants commonly receive red blood cell (RBC), platelet and fresh frozen plasma (FFP) transfusions. The aim of this Neonatal Transfusion Network survey was to describe current transfusion practices in Europe and to compare our findings to three recent randomised controlled trials to understand how clinical practice relates to the trial data.MethodsFrom October to December 2020, we performed an online survey among 597 neonatal intensive care units (NICUs) caring for infants with a gestational age (GA) of <32 weeks in 18 European countries.ResultsResponses from 343 NICUs (response rate: 57%) are presented and showed substantial variation in clinical practice. For RBC transfusions, 70% of NICUs transfused at thresholds above the restrictive thresholds tested in the recent trials and 22% below the restrictive thresholds. For platelet transfusions, 57% of NICUs transfused at platelet count thresholds above 25×109/L in non-bleeding infants of GA of <28 weeks, while the 25×109/L threshold was associated with a lower risk of harm in a recent trial. FFP transfusions were administered for coagulopathy without active bleeding in 39% and for hypotension in 25% of NICUs. Transfusion volume, duration and rate varied by factors up to several folds between NICUs.ConclusionsTransfusion thresholds and aspects of administration vary widely across European NICUs. In general, transfusion thresholds used tend to be more liberal compared with data from recent trials supporting the use of more restrictive thresholds. Further research is needed to identify the barriers and enablers to incorporation of recent trial findings into neonatal transfusion practice.

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Section: Discussionmentioning

confidence: 99%

Survey of transfusion practices in preterm infants in Europe

Scrivens

Reibel

Heeger

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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“…Oggi si distinguono: la TRALI di tipo 1, nel paziente che non ha fattori di rischio per un'ARDS con esordio acuto, ipossiemia e presenza documentata di infiltrati bilaterali e che non ha evidenza di ipertensione atriale sinistra (e deve esserci il fattore temporale); la TRALI di tipo 2, nel paziente che può avere fattori di rischio per ARDS ma che non ha un'ARDS diagnosticata (25).…”

Section: Conclusioniunclassified

Plasma, platelets and cryoprecipitates therapies

Agostini

2022

abtpn

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The present review gives an overview of the components, applications and risks of transfusion therapy. Fresh frozen plasma (FFP) transfusion is a widely used procedure both in a prophylactic and therapeutic context. In both scenarios the method of administration and the dosage are, improperly, the same; it is reported that in the clinical context FFP is inappropriately used in over 50% of cases. According to different guidelines its only recommended use is in a condition of critical hemorrhage, as there is no evidence of positive outcomes in its prophylactic administration. Platelet concentrates (PCs) are broadly used to support patients with thrombocytopenia, whether it is pre or postoperative, or in intensive care medicine. The only consensus on its use is the prophylactic administration when the patient’s platelet count is lower than 10,000. Another use of PCs can be in reducing side effects and enhancing the effects of specific drugs, although this application is still complex. Cryoprecipitate usage in clinics is decreasing both due to its variable content of factors I, VIII, XIII and von Willebrand, and the amount of time necessary to obtain it. Of great importance in the transfusion therapy framework are the respiratory complications that can occur, such as Transfusion-Associated Cardiac Overload (TACO), Transfusion-Related Acute Lung Injury (TRALI), Transfusion-Associated Dyspnea (TAD) and transfusion-induced sepsis. The suggested procedure when any of these (and other) complications occur is to seek consultation from the transfusion medicine unit.

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“…Notable risk factors known to be associated with TACO include history of heart failure, renal failure, coagulopathy, and exposure to plasma or receiving multiple blood products concurrently 5,7–12 . While diuretics are effective in removing fluids in patients, clinical benefits of premedicating patients with diuretics to prevent TACO have not been conclusive 13–15 . In addition, a recent analysis published by Roubinian et al indicated the increased risks of developing TACO with the use of diuretics prior to transfusions 7 .…”

Section: Introductionmentioning

confidence: 99%

“…5,[7][8][9][10][11][12] While diuretics are effective in removing fluids in patients, clinical benefits of premedicating patients with diuretics to prevent TACO have not been conclusive. [13][14][15] In addition, a recent analysis published by Roubinian et al indicated the increased risks of developing TACO with the use of diuretics prior to transfusions. 7 Although prior studies have shed light on rates and potential risk factors associated with TACO, many of the study populations were limited more than five to a decade ago.…”

mentioning

confidence: 99%

Novel computational methods on electronic health record yields new estimates of transfusion‐associated circulatory overload in populations enriched with high‐risk patients

et al. 2023

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Background Transfusion‐associated circulatory overload (TACO) is a severe adverse reaction (AR) contributing to the leading cause of mortality associated with transfusions. As strategies to mitigate TACO have been increasingly adopted, an update of prevalence rates and risk factors associated with TACO using the growing sources of electronic health record (EHR) data can help understand transfusion safety. Study Design and Methods This retrospective study aimed to provide a timely and reproducible assessment of prevalence rates and risk factors associated with TACO. Novel natural language processing methods, now made publicly available on GitHub, were developed to extract ARs from 3178 transfusion reaction reports. Other patient‐level data were extracted computationally from UCSF EHR between 2012 and 2022. The odds ratio estimates of risk factors were calculated using a multivariate logistic regression analysis with case‐to‐control matched on sex and age at a ratio of 1:5. Results A total of 56,208 patients received transfusions (total 573,533 units) at UCSF during the study period and 102 patients developed TACO. The prevalence of TACO was estimated to be 0.2% per patient (102/total 56,208). Patients with a history of coagulopathy (OR, 1.36; 95% CI, 1.04–1.79) and transplant (OR, 1.99; 95% CI, 1.48–2.68) were associated with increased odds of TACO. Discussion While TACO is a serious AR, events remained rare, even in populations enriched with high‐risk patients. Novel computational methods can be used to find and continually surveil for transfusion ARs. Results suggest that patients with history or presence of coagulopathy and organ transplant should be carefully monitored to mitigate potential risks of TACO.

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Pulmonary complications of transfusion: Changes, challenges, and future directions

Cited by 6 publications

References 26 publications

Survey of transfusion practices in preterm infants in Europe

Survey of transfusion practices in preterm infants in Europe

Plasma, platelets and cryoprecipitates therapies

Novel computational methods on electronic health record yields new estimates of transfusion‐associated circulatory overload in populations enriched with high‐risk patients

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