[Unclear acute respiratory failure in a 64-year-old woman after coronary intervention].
METHODS
Due to a retroperitoneal hematoma after cardiac catheterization a 64 year-old woman received two concentrates of red blood cells. Within two hours after transfusion the patient developed acute dyspnoea, anxiety and shivering.


METHODS
Computertomography (CT) of the chest revealed a new bilateral, basally accented pulmonary edema. Pulmonary embolism was ruled out. A cardiac cause in terms of cardiogenic shock had been excluded by echocardiography and other non-invasive measurements. Moreover, no circulatory overload (transfusion-associated circulatory overload [TACO]) after transfusion was presented and the stable size of the retroperitoneal hematoma excluded haemorrhagic shock. Hence, the clinical pattern pointed towards a transfusion-related acute lung injury (TRALI).


METHODS
The patient was intubated and a catecholamine medication was initiated. The weaning process proceeded without complications and the patient was extubated after several days. In the following chest x-ray no pulmonary residuals were left. After two weeks the patient was transferred to a rehabilitation unit.


CONCLUSIONS
TRALI is a life-threatening and an often unconsidered complication after transfusion of plasma containing blood products. According to the criteria of the european haemovigilance networks (EHN-criteria), TRALI is diagnosed by clinical and radiological parameters. In case of suspicious TRALI the involved transfusion center has to be informed. By a crossmatch between donor plasma and recipient granulocytes the causal antibodies are detected in most cases. In 17% of cases no antibodies are detected.
Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany. Vedat.Tiyerili@ukb.uni-bonn.de
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V
Tiyerili
U M
UM
Becher
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K
Strach
C F
CF
Mueller
G
G
Nickenig
J O
JO
Schwab
D055371:Acute Lung Injury / Q000175:diagnosis* / Q000628:therapy; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002395:Catecholamines / Q000008:administration & dosage; D003131:Combined Modality Therapy; D023903:Coronary Restenosis / Q000628:therapy*; D054855:Drug-Eluting Stents; D004452:Echocardiography; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006406:Hematoma / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007380:Intermediate Care Facilities; D007442:Intubation, Intratracheal; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D009204:Myocardial Revascularization; D011654:Pulmonary Edema / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012187:Retroperitoneal Space; D014057:Tomography, X-Ray Computed; D015300:Ventilator Weaning
D002395:Catecholamines