Transfusion-related acute lung injury: report of a clinical look-back investigation.
BACKGROUND
Transfusion-related acute lung injury (TRALI) is a syndrome that includes dyspnea, hypotension, bilateral pulmonary edema, and fever. TRALI is the third leading cause of transfusion-related mortality, but it is probably underdiagnosed and underreported.


OBJECTIVE
To determine if blood products from a frequent plasma donor, whose blood product was implicated in a fatal case of TRALI, caused symptoms of TRALI in other recipients of her plasma.


METHODS
Retrospective chart review (conducted from November 2000 through April 2001) of 50 patients who received blood components within 2 years (October 1998 through October 2000) from a donor linked to a transfusion-related fatality.


METHODS
Occurrence of mild/moderate (dyspnea with fever, chills, hypotension, and/or hypoxemia) or severe (acute pulmonary edema or need for mechanical ventilation) reaction associated with transfusion.


RESULTS
Superimposed illness prevented assessment of TRALI in 14 patients. Of the 36 patient charts that could be reviewed, 7 mild/moderate reactions were reported in 6 patients (16.7%) and 8 severe reactions were reported in 8 patients (22.2%). Of 5 patients who received multiple transfusions from the same donor, 2 experienced 2 reactions: one had 2 mild/moderate reactions and the other had both a mild/moderate and a severe reaction. While 5 of the 7 mild/moderate reactions were reported to the hospital transfusion service, only 2 of the 8 severe reactions were reported. Only 2 reactions (1 mild/moderate and 1 severe) were reported to the regional blood collection facility.


CONCLUSIONS
TRALI was frequently underdiagnosed and underreported in recipients of blood products from a donor whose blood products may have caused TRALI in several transfusion recipients. Clinical education and awareness of this often-overlooked diagnosis are imperative for appropriate prevention and treatment.
Kopko
Patricia M
PM
Sacramento Blood Centers, 1625 Stockton Blvd, Sacramento, CA 95816, USA. patricia.kopko@smfbc.org
Marshall
Carol S
CS
MacKenzie
Malcolm R
MR
Holland
Paul V
PV
Popovsky
Mark A
MA
D000208:Acute Disease; D001782:Blood Donors; D016358:Contact Tracing; D004417:Dyspnea / Q000209:etiology; D005334:Fever / Q000209:etiology; D006801:Humans; D007022:Hypotension / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010949:Plasma; D011654:Pulmonary Edema / Q000209:etiology; D012128:Respiratory Distress Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D065227:Transfusion Reaction