[Acute dyspnoea following transfusion of plasma-containing blood products].
A 35-year-old male patient who was given chemotherapy because of chronic myeloid leukaemia became dyspnoeic after transfusion of thrombocytes; initially, no explanation could be found for this dyspnoea. He went home before all diagnostic procedures were evaluated. Chest X-ray revealed bilateral pulmonary oedema, which could be due to transfusion-related acute lung injury (TRALI), especially since there were no indications for a cardiac aetiology. The patient was sent to the nearest hospital where he was treated with diuretics and observed for 24 hours. There were no complications. The pathogenesis of TRALI has been attributed to an interaction between anti-granulocyte antibodies and granulocytes. In addition, bioactive compounds produced during the storage of blood products have been implicated. It is important to recognize TRALI as the cause of dyspnoea when cardiac or pulmonary causes are excluded. The overall prognosis is good when treatment is started in time. The management of TRALI is supportive, with mechanical ventilation when necessary. After excluding donors with proven anti-granulocyte antibodies from further donation, there is no increased risk for recurrent episodes after future transfusion of plasma-containing blood products.
Kessels
L W
LW
VU Medisch Centrum, afd. Hematologie, Postbus 7057, 1007 MB Amsterdam. l.kessels@vumc.nl
Visser
O J
OJ
D000208:Acute Disease; D000328:Adult; D001787:Blood Group Incompatibility; D004232:Diuretics / Q000627:therapeutic use; D004417:Dyspnea / Q000209:etiology*; D006801:Humans; D008297:Male; D017713:Platelet Transfusion / Q000009:adverse effects*; D011379:Prognosis; D011654:Pulmonary Edema / Q000188:drug therapy / Q000209:etiology; D012128:Respiratory Distress Syndrome / Q000188:drug therapy / Q000209:etiology*; D016896:Treatment Outcome
D004232:Diuretics