title: Perioperative transfusion-related acute lung injury: the Canadian Blood Services experience.
abstract: OBJECTIVE
  Transfusion-related acute lung injury (TRALI) is a devastating transfusion-associated adverse event. There is a paucity of data on the incidence and characteristics of TRALI cases that occur perioperatively. We classified suspected perioperative TRALI cases reported to Canadian Blood Services between 2001 and 2012, and compared them to non-perioperative cases to elucidate factors that may be associated with an increased risk of developing TRALI in the perioperative setting.
  
  
  METHODS
  All suspected TRALI cases reported to Canadian Blood Services (CBS) since 2001 were reviewed by two experts or, from 2006 to 2012, the CBS TRALI Medical Review Group (TMRG). These cases were classified based on the Canadian Consensus Conference (CCC) definitions and detailed in a database. Two additional reviewers further categorized them as occurring within 72 h from the onset of surgery (perioperative) or not in that period (non-perioperative). Various demographic and characteristic variables of each case were collected and compared between groups.
  
  
  RESULTS
  Between 2001 and 2012, a total of 469 suspected TRALI cases were reported to Canadian Blood Services; 303 were determined to be within the TRALI diagnosis spectrum. Of those, 112 (38%) were identified as occurring during the perioperative period. Patients who underwent cardiac surgery requiring cardiopulmonary bypass (25.0%), general surgery (18.0%) and orthopedics patients (12.5%) represented the three largest surgical groups. Perioperative TRALI cases comprised more men (53.6% vs. 41.4%, p=0.04) than non-perioperative patients. Perioperative TRALI patients more often required supplemental O2 (14.3% vs. 3.1%, p=0.0003), mechanical ventilation (18.8% vs. 3.1%), or were in the ICU (14.3% vs. 3.7%, p=0.0043) prior to the onset of TRALI compared to non-perioperative TRALI patients. The surgical patients were transfused on average more components than non-perioperative patients (6.0 [SD=8.3] vs. 3.6 [5.2] products per patient, p=0.0002). Perioperative TRALI patients were transfused more plasma (152 vs. 105, p=0.013) and cryoprecipitate (51 vs. 23, p<0.01) than non-perioperative TRALI patients. There was no difference between donor antibody test results between the groups.
  
  
  CONCLUSIONS
  CBS data has provided insight into the nature of TRALI cases that occur perioperatively; this group represents a large proportion of TRALI cases.
authors.affiliation: Department of Anesthesia, Sunnybrook Health Sciences Centre, Canada; Department of Laboratory Medicine & Pathobiology, University of Toronto, Canada. Electronic address: asim.alam@sunnybrook.ca.
authors.forename: Asim
authors.initials: A
authors.lastname: Alam
authors.affiliation: Canadian Blood Services, Central Ontario, Canada.
authors.forename: Mary
authors.initials: M
authors.lastname: Huang
authors.affiliation: Canadian Blood Services, Central Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Canada.
authors.forename: Qi-Long
authors.initials: QL
authors.lastname: Yi
authors.affiliation: Department of Laboratory Medicine & Pathobiology, University of Toronto, Canada; Department of Clinical Pathology, Sunnybrook Health Sciences Centre, Canada.
authors.forename: Yulia
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Canadian Blood Services, Central Ontario, Canada.
authors.forename: Barbara
authors.initials: B
authors.lastname: Hannach
mesh_terms: D055371:Acute Lung Injury / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D000367:Age Factors; D000368:Aged; D002170:Canada / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D012189:Retrospective Studies; D012737:Sex Factors; D065227:Transfusion Reaction
keywords: Lung injury; Perioperative; Surgery; TRALI; Transfusion reactions