Swanson Kelly, Dwyre Denis M, Krochmal Jessica, Raife Thomas J
Department of Internal Medicine, University of Iowa, 200 Hawkins Drive, Iowa city, IA, 52242, USA.
Lung. 2006 May-Jun;184(3):177-85. doi: 10.1007/s00408-005-2578-8.
Transfusion-related acute lung injury (TRALI) is a rare transfusion reaction presenting as respiratory distress during or after transfusion of blood products. TRALI varies in severity, and mortality is not uncommon. TRALI reactions have equal gender distributions and can occur in all age groups. All blood products, except albumin, have been implicated in TRALI reactions. TRALI presents as acute respiratory compromise occurring in temporal proximity to a transfusion of a blood product. Other causes of acute lung injury should be excluded in order to definitively diagnose TRALI. Clinically and pathologically, TRALI mimics acute respiratory distress syndrome (ARDS), with neutrophil-derived inflammatory chemokines and cytokines believed to be involved in the pathogenesis of both entities. Anti-HLA and anti-neutrophil antibodies have been implicated in some cases of TRALI. Treatment for TRALI is supportive; prevention is important. It is suspected that TRALI is both underdiagnosed and underreported. One of the difficulties in the evaluation of potential TRALI reactions is, until recently, the lack of diagnostic criteria. A group of transfusion medicine experts, the American-European Consensus Conference (AECC), recently met and developed diagnostic criteria of TRALI, as well as recommendations for management of donors to prevent future TRALI reactions. In light of the AECC consensus recommendations, we report an incident of TRALI in an oncology patient as an example of the potential severity of the lung disease and the clinical and laboratory evaluation of the patient. We also review the literature on this important complication of blood transfusion that internists may encounter.
输血相关急性肺损伤（TRALI）是一种罕见的输血反应，表现为在输注血液制品期间或之后出现呼吸窘迫。TRALI的严重程度各不相同，死亡率并不罕见。TRALI反应在性别分布上相等，可发生于所有年龄组。除白蛋白外，所有血液制品都与TRALI反应有关。TRALI表现为在输注血液制品后短期内出现的急性呼吸功能不全。为明确诊断TRALI，应排除急性肺损伤的其他病因。在临床和病理上，TRALI类似于急性呼吸窘迫综合征（ARDS），中性粒细胞衍生的炎症趋化因子和细胞因子被认为参与了这两种疾病的发病机制。抗人白细胞抗原（HLA）和抗中性粒细胞抗体在某些TRALI病例中被认为有牵连。TRALI的治疗以支持治疗为主；预防很重要。据推测，TRALI存在诊断不足和报告不足的情况。直到最近，评估潜在TRALI反应的困难之一是缺乏诊断标准。一组输血医学专家，即美欧共识会议（AECC），最近会面并制定了TRALI的诊断标准，以及关于供体管理的建议，以预防未来的TRALI反应。根据AECC的共识建议，我们报告一例肿瘤患者发生TRALI的事件，以此为例说明这种肺部疾病的潜在严重性以及对该患者的临床和实验室评估。我们还回顾了内科医生可能遇到的这种重要输血并发症的相关文献。
