وصف
A dangerous and sometimes fatal side effect of blood product transfusion is known as transfusion-related acute lung injury (TRALI), in which a patient has noncardiogenic pulmonary edema and fast onset lung injury as a result of the activation of immune cells in the lungs. It is a new acute lung injury (ALI), unrelated to any other ALI risk factor, that develops during or within six hours of transfusion. With fever, chills, and hypoxemic respiratory failure, it has the potential to be fatal. Its pathogenesis and diagnostic standards are still being explored given that it is a clinically diagnosed syndrome.
ملخص
- A 32-year-old female, already dengue-positive and thrombocytopenic, was admitted with fever, headache, and breathing difficulty, evolving into a class 3 dyspnea. Initial vitals showed elevated heart rate, normal blood pressure, and adequate oxygen saturation, but further testing revealed worsening thrombocytopenia despite platelet transfusions.
- The patient developed bleeding manifestations (lung hemorrhage), rash, and increasing respiratory distress, requiring supplemental oxygen. Platelet counts remained low despite additional transfusions. Differential diagnoses considered included pulmonary issues and transfusion-related complications like TRALI and TACO, necessitating a shift to the ICU.
- TRALI (Transfusion-Related Acute Lung Injury) is a clinical syndrome of non-cardiogenic pulmonary edema and hypoxia occurring during or within six hours of transfusion. The two-hit hypothesis suggests primed neutrophils in already-ill patients are activated by antibodies in transfused blood products, leading to capillary leakage and pulmonary edema.
- Clinical presentation of TRALI involves dyspnea, fever, hypotension, and increased oxygen requirement. Unlike TACO, there is no evidence of fluid overload or cardiogenic edema. The condition is diagnosed clinically, excluding sepsis and cardiogenic causes.
- Initial management involves stopping the transfusion and notifying the blood bank. TRALI recovery usually occurs within 2-4 days, and its incidence has been reduced using plasma from male donors and screening female donors for HLA antibodies.
- Differential diagnosis of TRALI includes ARDS and TACO (Transfusion-Associated Circulatory Overload), another cause of acute dyspnea. While both conditions share similar symptoms, TACO presents with fever, hypertension, and signs of circulatory overload.
- Key distinctions between TRALI and TACO involve fluid balance, ejection fraction, BNP levels, and response to diuretics. TACO patients exhibit circulatory overload, decreased ejection fraction, elevated BNP, and improvement with diuretics, which are not seen in TRALI. X-ray findings also differ, with alveolar shadows in TRALI versus cardiomegaly and vascular congestion in TACO.
- Prevention of TRALI is paramount due to the lack of definitive treatment. Minimizing blood transfusions and addressing underlying diseases are essential, alongside maintaining a high index of suspicion for prompt identification and management.
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