Rizk A, Gorson K C, Kenney L, Weinstein R
Section of Hematology and Transfusion Medicine, Division of Hematology/Oncology, St. Elizabeth's Medical Center of Boston, MA, USA.
Transfusion. 2001 Feb;41(2):264-8. doi: 10.1046/j.1537-2995.2001.41020264.x.
Transfusion-related acute lung injury (TRALI) is a well-characterized, serious complication of blood component therapy in hospitalized patients. The signs and symptoms are often attributed to other clinical aspects of a patient's condition, and therefore TRALI may go unrecognized. IVIG is a pooled plasma derivative commonly used in the outpatient setting. Respiratory complications of IVIG infusion have typically been attributed to volume overload or allergic and vasomotor reactions. TRALI has never been documented to occur after IVIG infusion.
A 23-year-old man with multifocal motor neuropathy developed noncardiogenic pulmonary edema 6 hours after receiving 90 g of IVIG by a rapid-infusion protocol. He fully recovered in 5 days with nasal oxygen and bed rest. Granulocyte-associated IgG was detected in his blood 14 and 27 weeks after the event. The lots of IVIG that he received were found to contain a low-titer, panreactive, granulocyte antibody, mostly IgG.
This is the first documented case of TRALI after IVIG infusion. An autoimmune syndrome, including autoantibody-coated granulocytes, may have been a priming stimulus for granulocyte interaction with pulmonary capillary endothelium. Rapid infusion of a large quantity of granulocyte antibody may have precipitated TRALI. A pooled plasma product or derivative may result in TRALI.
输血相关急性肺损伤（TRALI）是住院患者血液成分治疗中一种特征明确的严重并发症。其体征和症状常被归因于患者病情的其他临床方面，因此TRALI可能未被识别。静脉注射免疫球蛋白（IVIG）是门诊常用的一种混合血浆衍生物。IVIG输注的呼吸系统并发症通常归因于容量超负荷或过敏及血管舒缩反应。IVIG输注后从未有过TRALI发生的记录。
一名23岁多灶性运动神经病男性患者，通过快速输注方案接受90 g IVIG后6小时出现非心源性肺水肿。经鼻吸氧和卧床休息，他在5天内完全康复。事件发生后14周和27周在其血液中检测到粒细胞相关IgG。发现他所接受的IVIG批次含有低滴度、全反应性、粒细胞抗体，主要为IgG。
这是IVIG输注后首例有记录的TRALI病例。一种自身免疫综合征，包括自身抗体包被的粒细胞，可能是粒细胞与肺毛细血管内皮细胞相互作用的启动刺激因素。快速输注大量粒细胞抗体可能引发了TRALI。一种混合血浆产品或衍生物可能导致TRALI。
