[Anesthetic management of a patient with transfusion-related acute lung injury (TRALI)].
Transfusion-related acute lung injury (TRALI) is characterized by pulmonary edema and hypoxemia within 6 hours of transfusion in the absence of other causes of acute lung injury or circulatory overload and is now considered the leading cause of transfusion-related death. We report a female patient who showed hypoxemia after transfusion without any other causes of acute lung injury. The patient is a 43-year-old woman, who received emergency transurethral hemostasis for bladder hemorrhage with hematuria and low hemoglobin concentration (3.2 g x dl(-1)). General anesthesia was maintained with sevoflurane, remifentanil, and vecuronium. Two units of RBC were transfused during operation. Since she showed high blood pressure, tachycardia, and a painful expression after operation, we extubated her. Although we gave her O2 6 l x min(-1) after extubation, she showed low oxygen saturation (90%), thus we started bag-mask ventilation. However, she complained of dyspnea and the chest X-ray revealed bilateral diffuse pulmonary edema following hypoxemia (80%). Thus we inserted endotracheal tube and started positive pressure assist ventilation. The next day, hypoxemia was improved under PEEP therapy. The anti-HLA antibody in the transfused plasma was positive. We conclude that the early recognition and management of TRALI is essential during and after operation.
Sakata
Yuko
Y
Department of Anesthesia, National Saitama Hospital, Wako 351-0102.
Wada
Hiroki
H
Oshima
Takashi
T
Aramaki
Yoshihiko
Y
Kikuta
Yoshinori
Y
Iwasaki
Yasuji
Y
D000328:Adult; D000768:Anesthesia, General; D005260:Female; D006801:Humans; D011175:Positive-Pressure Respiration; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D065227:Transfusion Reaction