title: A prophylactic fresh frozen plasma transfusion leads to a possible case of transfusion-related acute lung injury.
abstract: A 39-year-old man with cholangiocarcinoma presented with fever and abdominal pain. He was hypotensive, jaundiced and had right upper quadrant tenderness. Laboratory testing showed a leucocytosis, elevated liver function tests, total bilirubin and International Normalised Ratio (INR). Given the concern for cholangitis, the patient was given antibiotics and three units of fresh frozen plasma (FFP) before biliary drain placement. After drain placement, and within 3 h of receiving blood products, the patient became tachypnoeic and hypoxic with a chest X-ray revealing new bilateral airspace disease. The rapid development of respiratory distress was determined to most likely be transfusion-related acute lung injury (TRALI). He rapidly progressed to intubation and required 100% FiO2, high positive-end expiratory pressure (PEEP) and intermittent-prone ventilation for 48 h but eventually recovered and was extubated. TRALI is an under-recognised aetiology for respiratory distress in the critically ill. Adopting a conservative transfusion strategy may prevent TRALI.
authors: Division of Pulmonary, Critical Care and Sleep Medicine, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA.
authors: Debasree
authors: D
authors: Banerjee
authors: Division of Pulmonary, Critical Care and Sleep Medicine, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA.
authors: Rashid
authors: R
authors: Hussain
authors: Division of Pulmonary, Critical Care and Sleep Medicine, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA.
authors: Jeffrey
authors: J
authors: Mazer
authors: Division of Pulmonary, Critical Care and Sleep Medicine, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA.
authors: Gerardo
authors: G
authors: Carino
mesh_terms: D055371:Acute Lung Injury / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D000328:Adult; D016913:Blood Component Transfusion / Q000009:adverse effects*; D016638:Critical Illness; D003937:Diagnosis, Differential; D004452:Echocardiography; D006801:Humans; D008297:Male; D010949:Plasma; D013902:Radiography, Thoracic; D012121:Respiration, Artificial