Transfusion-related acute lung injury or acute chest syndrome of sickle cell disease? - A case report.
OBJECTIVE
To describe how to differentiate transfusion-related acute lung injury from acute chest syndrome of sickle cell disease.


METHODS
A neurosurgical patient with sickle cell disease received two units of packed red blood cells postoperatively. Four hours later she developed progressive respiratory distress, diffuse geographical airspace disease and bilateral pulmonary edema. The patient recovered sufficiently to be transferred from the intensive care unit within four days. The temporal relationship to transfusion, features on computerized tomographic scan, and the rapid resolution of severe edema point to a diagnosis of transfusion related acute lung injury. Granulocyte or human leukocyte antigen antibodies in donor plasma may confirm a diagnosis of transfusion injury.


CONCLUSIONS
The clinician should appreciate that erythrocyte transfusion to prevent or treat acute chest syndrome may cause transfusion related acute lung injury, a condition that mimics, exacerbates or possibly triggers the syndrome it was intended to treat.
Firth
Paul G
PG
Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA. pfirth@partners.org
Tsuruta
Yoshihiko
Y
Kamath
Yogish
Y
Dzik
Walter H
WH
Ogilvy
Christopher S
CS
Peterfreund
Robert A
RA
D000208:Acute Disease; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000628:therapy; D003937:Diagnosis, Differential; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D011654:Pulmonary Edema / Q000150:complications / Q000175:diagnosis; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000175:diagnosis* / Q000209:etiology; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures / Q000009:adverse effects