Pulmonary edema after transfusion in a patient with end-stage renal disease.
OBJECTIVE
To describe a patient with end-stage renal disease who developed non-cardiogenic pulmonary edema after transfusion of packed red blood cells.


METHODS
Case report and literature review.


RESULTS
The patient under consideration is a 60-year-old woman who developed acute pulmonary edema after transfusion of packed red blood cells without concomitant dialysis. The initial diagnosis of fluid overload was managed by isolated ultrafiltration. Minimal fluid removal led to significant hypotension that was resistant to vasopressors. Subsequent pulmonary artery catheter readings were consistent with non-cardiogenic pulmonary edema. The patient improved spontaneously over the next few days with supportive care only. Plasma from the donors was checked for granulocyte antibodies and antibodies to HLA class I antigens. No granulocyte antibodies were detected in donor plasma but of one the HLA antibodies detected in donor plasma had specificity for a recipient HLA-A antigen. These characteristics supported a final diagnosis of transfusion-related acute lung injury (TRALI).


CONCLUSIONS
Acute pulmonary edema following blood transfusion in a dialysis-dependent patient does not always signify fluid overload and nephrologists should be aware of the alternative diagnosis of TRALI. Proper awareness of TRALI will lead to prompt diagnosis and appropriate management.
Guglin
M
M
Division of Cardiology, UMDNJ/Robert Wood Johnson Medical School, The Cooper Health System, Camden, New Jersey 08103, USA.
Dey
C
C
Meny
G M
GM
Sultan
W
W
Weisberg
L S
LS
D000740:Anemia / Q000628:therapy; D003937:Diagnosis, Differential; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology*; D008875:Middle Aged; D011654:Pulmonary Edema / Q000175:diagnosis / Q000209:etiology*; D006435:Renal Dialysis; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000209:etiology*