Transfusion-Related Acute Lung Injury

摘要

It has been about 20 years since the first reports of transfusion-related acute lung injury (TRALI) by Popovsky and Moore. Even so, we have yet to determine the incidence and mechanisms responsible for the development of TRALI, a potentially fatal transfusion reaction. It is important for clinicians to recognize that TRALI should be considered in the differential diagnosis in the setting of new or worsening acute lung injury within 6 hr of a plasma-containing blood product. Most importantly, one needs to differentiate TRALI, a non-cardiogenic pulmonary edema syndrome, from transfusion-associated circulatory overload (TACO). TACO usually occurs within 2 hr of transfusion. Infants and recipients over the age of 60 are at increased risk. The clinical presentation is respiratory distress. The patient may have increased blood pressure, heart rate, and central venous pressure as well as an increased wedge pressure. Unlike TRALI, patients with TACO respond to diuretics. Clinically useful tests to differentiate between cardiogenic pulmonary edema and TRALI include B-type natriuretic peptide (BNP) and determination of the protein concentration in the pulmonary edema fluid and serum. A ratio greater than or equal to 75 indicates the fluid to be an exudate (acute lung injury and permeability edema) rather than a transudate indicative of cardiogenic pulmonary edema. The BNP is a biochemical marker of volume and pressure overload.