Bux J
DRK Blood Service West, Hagen, Germany.
Vox Sang. 2005 Jul;89(1):1-10. doi: 10.1111/j.1423-0410.2005.00648.x.
Analyses of fatal transfusion reactions in the UK and USA have shown that transfusion-related acute lung injury (TRALI) is among the most common causes of fatal transfusion reactions.
Review of the literature was used to analyse TRALI.
TRALI is characterized by acute respiratory distress and non-cardiogenic lung oedema developing during, or within 6 h of, transfusion. In atypical cases, TRALI can become symptomatic much later. TRALI must be carefully differentiated from transfusion-associated circulatory overload. In its fulminant presentation, TRALI can be clinically indistinguishable from acute respiratory distress syndrome occurring as a result of other causes. The severity of TRALI depends upon the susceptibility of the patient to develop a more clinically significant reaction as a result of an underlying disease process, and upon the nature of triggers in the transfused blood components, including granulocyte-binding alloantibodies (immune TRALI) or neutrophil-priming substances such as biologically active lipids (non-immune TRALI). Immune TRALI, which occurs mainly after the transfusion of fresh-frozen plasma and platelet concentrates, is a rare event (about one incidence per 5000 transfusions) but frequently ( approximately 70%) requires mechanical ventilation (severe TRALI) and is not uncommonly fatal (6-9% of cases). Non-immune TRALI, which occurs mainly after the transfusion of stored platelet and erythrocyte concentrates, seems to be characterized by a more benign clinical course, with oxygen support sufficient as a form of therapy in most cases, and a lower mortality than immune TRALI.
By virtue of its morbidity and mortality, TRALI has become one of the most serious current complications of transfusion. To prevent further antibody-mediated cases, the evaluation of TRALI should include leucocyte antibody testing of implicated donors. However, further studies are necessary for the prevention of this serious transfusion complication.
对英国和美国致命输血反应的分析表明，输血相关急性肺损伤（TRALI）是致命输血反应最常见的原因之一。
通过文献回顾分析TRALI。
TRALI的特征为在输血期间或输血后6小时内出现急性呼吸窘迫和非心源性肺水肿。在非典型病例中，TRALI可能在很久之后才出现症状。必须仔细将TRALI与输血相关循环超负荷区分开来。在其暴发性表现中，TRALI在临床上可能与其他原因导致的急性呼吸窘迫综合征无法区分。TRALI的严重程度取决于患者因潜在疾病过程而发生更具临床意义反应的易感性，以及所输注血液成分中触发因素的性质，包括粒细胞结合同种抗体（免疫性TRALI）或中性粒细胞启动物质，如生物活性脂质（非免疫性TRALI）。免疫性TRALI主要发生在输注新鲜冰冻血浆和血小板浓缩物之后，是一种罕见事件（每5000次输血约有1例发生），但频繁（约70%）需要机械通气（严重TRALI），且并非不常见地致命（6 - 9%的病例）。非免疫性TRALI主要发生在输注储存的血小板和红细胞浓缩物之后，其临床病程似乎更为良性，大多数情况下氧疗作为一种治疗形式就足够了，且死亡率低于免疫性TRALI。
鉴于其发病率和死亡率，TRALI已成为当前最严重的输血并发症之一。为防止进一步的抗体介导病例，TRALI的评估应包括对相关献血者进行白细胞抗体检测。然而，预防这种严重输血并发症还需要进一步研究。
