[Case of severe transfusion-related acute lung injury during coronary artery bypass surgery].
We report a case of transfusion-related acute lung injury (TRALI) during coronary artery bypass surgery. A 73-year-old man developed severe hypoxemia after transfusion of platelet concentrate just before completion of surgery. The possibility of cardiogenic pulmonary edema was excluded by transesophageal echocardiography. A chest X-ray showed bilateral pulmonary edema, suggesting TRALI. Steroid therapy and administration of sivelestat sodium hydrate and vasopressors were started. The patient's PaO2 /FIO2 ratio increased from 56 to 223 within 12 hrs. Anti-HLA and antigranulocyte antibodies were detected in the donated blood products. We assume that the cause of this case was an immune reaction through anti-HLA and/or antigranulocyte antibodies. TRALI is a potentially life-threatening, underrecognized and under-reported complication of transfusion. A better understanding and awareness is needed for medical staffs.
Nagashima
Michio
M
Asahikawa Medical College, Asahikawa 078-8510.
Kunisawa
Takayuki
T
Kurosawa
Atsushi
A
Takahashi
Kazuhiro
K
Harada
Hideyuki
H
Takahata
Osamu
O
Iwasaki
Hiroshi
H
D000368:Aged; D000787:Angina Pectoris / Q000601:surgery; D000906:Antibodies; D001026:Coronary Artery Bypass; D005998:Glycine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006098:Granulocytes / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D008297:Male; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000628:therapy; D012720:Severity of Illness Index; D013449:Sulfonamides / Q000627:therapeutic use; D065227:Transfusion Reaction
D000906:Antibodies; D006680:HLA Antigens; D013449:Sulfonamides; C069195:sivelestat; D005998:Glycine