Gajic Ognjen, Moore S Breanndan
Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Mayo Clin Proc. 2005 Jun;80(6):766-70. doi: 10.1016/S0025-6196(11)61531-0.
Transfusion-related acute lung injury (TRALI) is characterized by the sudden development of noncardlogenic pulmonary edema (acute lung Injury) after transfusion of blood products. Poor awareness of TRALI outside of the blood transfusion medicine community has led to a serious underestimation of this condition, currently the most Important severe complication of blood transfusion. Concern for the transfer of donor antileukocyte antibodies has prompted major changes in the management of the blood supply in some countries; however, recent studies have suggested alternative pathophyslological mechanisms for TRALI related to the shelf life of cellular blood products. Although all blood products have been implicated, most reported cases were associated with fresh frozen plasma, red blood cell, and platelet transfusions. Because many patients have additional predisposing factors for acute lung injury, carefully designed prospective studies are needed to fully assess attributable risk related to transfusion. The treatment of TRALI is supportive, and the prognosis is generally better than for other causes of acute lung Injury. As many as one third of all patients who develop acute lung injury have been exposed to blood products. TRALI may be an important and potentially preventable cause of acute lung injury.
输血相关急性肺损伤（TRALI）的特征是在输注血液制品后突然发生非心源性肺水肿（急性肺损伤）。输血医学领域之外对TRALI的认识不足，导致对这种疾病严重低估，目前它是输血最重要的严重并发症。对供体抗白细胞抗体转移的担忧促使一些国家在血液供应管理方面发生了重大变化；然而，最近的研究提出了与细胞血液制品保存期限相关的TRALI替代病理生理机制。虽然所有血液制品都有涉及，但大多数报告病例与新鲜冰冻血浆、红细胞和血小板输注有关。由于许多患者有急性肺损伤的其他易感因素，需要精心设计前瞻性研究以充分评估与输血相关的归因风险。TRALI的治疗是支持性的，其预后通常优于其他急性肺损伤病因。所有发生急性肺损伤的患者中，多达三分之一曾接触过血液制品。TRALI可能是急性肺损伤的一个重要且潜在可预防的病因。
