Transfusion-related acute lung injury in ICU patients admitted with gastrointestinal bleeding

Abstract

Purpose Transfusion of blood components is common in patients admitted to the intensive care unit (ICU) for gastrointestinal (GI) bleeding, yet the incidence and risk factors for development of transfusion-related acute lung injury (TRALI) in these patients are unknown. Methods Patients admitted to a medical ICU for GI bleeding (n = 225) were analyzed for patient-and transfusion-specific risk factors for development of TRALI. Results In transfused patients (n = 150), the incidence of TRALI was 15% [95% confidence interval (CI), 10–21%] and accounted for 76% (22/29) of all acute lung injury (ALI) cases. Transfused patients with end-stage liver disease (ESLD) (n = 72) developed TRALI more frequently than those without ESLD (29% versus 1%, p < 0.01). Fresh frozen plasma (FFP) was temporally associated with TRALI in 86% of cases. Transfusion-specific risk factors for development of TRALI included number of transfused units of FFP and nonleukoreduced red blood cells. Patient-specific risk factors included Model for End-Stage Liver Disease (MELD) score, admission serum albumin level, and presence of ALI risk factors. Conclusions TRALI is common in critically ill ESLD patients with gastrointestinal bleeding. Nonleukoreduced red blood cells and FFP are significant transfusion-specific risk factors and their use should be re-evaluated in bleeding patients with ESLD.

Impact of Implementation of Rotem on Allogenic Blood Transfusions in Trauma Patients Following ICU Admission before and after Study

“…Furthermore we notified a significant reduction in the development of ARDS, which may be causally linked to a reduced transfusion of fresh frozen plasma in these patients. This is an interesting and at least potentially essential observation for that the transfusion of FFP has also been shown to be responsible for the development of TRALI [33][34][35]. More and above, the reduction of FFP administration itself may also be responsible for the reduction of pRBC transfusion as observed in our present study and has also been shown in a prospective cohort study by Innerhofer and coworkers [36].…”

The incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of cardiac surgery patients: a prospective nested case-control study

“…[1][2][3][4] TRALI is defined as the acute onset of hypoxia and bilateral pulmonary infiltrates, in temporal relation to a blood transfusion. 1,5 Although the absence of specific disease markers and diagnostic tests has resulted in a large variation in estimations of incidence, 1,[6][7][8][9][10][11][12][13][14] TRALI is generally considered to be a rare event. However, TRALI is underdiagnosed and under-reported.…”

The Epidemiology of Transfusion-related Acute Lung Injury Varies According to the Applied Definition of Lung Injury Onset Time

“…Only one (21) of seven contemporary studies examining patientrelated TRALI risk factors (4,(6)(7)(8)(21)(22)(23) details how the investigators determined ARDS onset time. Other studies found that expert investigators frequently do not agree on the radiographic definition of ARDS (24,25), which further adds to the concern of unreliability of the TRALI definition raised by our study.…”