title: Acute lung injury after ruptured abdominal aortic aneurysm repair: the effect of excluding donations from females from the production of fresh frozen plasma.
abstract: OBJECTIVE
  Transfusion-related acute lung injury may contribute to the development of acute lung injury in the critically ill, due to plasma from female donors containing antileukocyte antibodies. In July 2003, the U.K. National Blood Service stopped using female donor plasma for the production of fresh frozen plasma. Patients undergoing repair of a ruptured abdominal aortic aneurysm receive large amounts of fresh frozen plasma and often develop acute lung injury. We investigated whether the change to male fresh frozen plasma was associated with a change in the frequency of acute lung injury in these patients.
  
  
  METHODS
  A retrospective, before and after, observational, single-center study.
  
  
  METHODS
  Tertiary care center and a regional blood center.
  
  
  METHODS
  The study included 211 patients undergoing open repair of a ruptured abdominal aortic aneurysm between 1998 and 2006.
  
  
  METHODS
  None.
  
  
  RESULTS
  Primary outcome was the development of acute lung injury in the first 6 hrs after surgery. Secondary outcomes were significant hypoxia (PaO2/FiO2 ratio <300), time to extubation, and survival at 30 days. Groups were well matched and received similar volumes of intravenous fluids and blood components. There was significantly less acute lung injury following the change to male fresh frozen plasma (36% before vs. 21% after, p = .04). At 6 hrs after surgery, fewer patients were hypoxic (87% before vs. 62% after, p < .01). In multivariate analysis, the change in donor policy was associated with a decreased risk of developing acute lung injury (odds ratio 0.39; 95% confidence interval, 0.16-0.90). Time to extubation and survival at 30 days were not statistically different between groups.
  
  
  CONCLUSIONS
  The policy to exclude female donors from the production of fresh frozen plasma was associated with a decrease in the frequency of acute lung injury in patients undergoing repair of a ruptured abdominal aortic aneurysm.
authors.affiliation: Department of Perioperative and Critical Care, Freeman Hospital, Newcastle upon Tyne, United Kingdom. s.e.wright@dsl.pipex.com
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Wright
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Snowden
authors.forename: Sally C
authors.initials: SC
authors.lastname: Athey
authors.forename: Alice A
authors.initials: AA
authors.lastname: Leaver
authors.forename: Jill-Marie
authors.initials: JM
authors.lastname: Clarkson
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Chapman
authors.forename: David R D
authors.initials: DR
authors.lastname: Roberts
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Wallis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000097:blood / Q000401:mortality / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000401:mortality / Q000601:surgery*; D016913:Blood Component Transfusion / Q000009:adverse effects*; D001782:Blood Donors; D003422:Critical Care; D004730:Endothelium, Vascular / Q000276:immunology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D008297:Male; D010949:Plasma; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D012307:Risk Factors; D014930:Women
chemical_list: D007518:Isoantibodies