Report of a patient with severe transfusion-related acute lung injury after multiple transfusions, resuscitated with albumin.
OBJECTIVE
To report a patient with a large gastrointestinal stromal tumor (GIST) who received multiple blood transfusions intraoperatively and developed a transfusion-related acute lung injury (TRALI).


METHODS
Case report.


METHODS
Intensive care unit of a tertiary care hospital. PATIENT AND HISTORY: A 58-year-old man with GIST metastatic to the right lobe of the liver, treated with tyrosine kinase inhibitors, underwent a right hepatectomy requiring multiple transfusions. Prior to abdominal closure, he developed copious pulmonary secretions, hypoxemia, and hypotension. Chest radiograph revealed diffuse bilateral infiltrates.


METHODS
Volume resuscitation, vasopressors, high PEEP mechanical ventilation, paralysis, nitric oxide, steroids, rapid albumin infusion.


RESULTS
Extensive noncardiogenic pulmonary edema. After unsuccessful fluid resuscitation with crystalloid fluid, the patient's condition improved rapidly with human albumin boluses. No neurological deficit was detected despite prolonged hypoxemia. Acute renal failure required dialysis but with subsequent recovery. Patient was discharged home on postoperative day 19.


CONCLUSIONS
Rapid infusion of albumin might be a rescue option in cases of severe TRALI with extensive pulmonary capillary leak during the acute phase.
Djalali
Alimorad G
AG
Department of Anesthesiology, Perioperative Pain Medicine and Intensive Care, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. adjalali@partners.org
Moore
Kimberly A
KA
Kelly
Edward
E
D000208:Acute Disease; D000418:Albumins / Q000627:therapeutic use*; D001803:Blood Transfusion / Q000379:methods; D016638:Critical Illness / Q000628:therapy; D005500:Follow-Up Studies; D046152:Gastrointestinal Stromal Tumors / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000188:drug therapy* / Q000209:etiology; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000209:etiology; D012151:Resuscitation / Q000379:methods; D018570:Risk Assessment; D065227:Transfusion Reaction; D016896:Treatment Outcome
D000418:Albumins