Skeate Robert C, Eastlund Ted
American Red Cross, North Central Blood Services, Saint Paul, MN 55107, USA.
Curr Opin Hematol. 2007 Nov;14(6):682-7. doi: 10.1097/MOH.0b013e3282ef195a.
The purpose of this review is to provide an overview of concepts recently presented in the literature that impact our understanding of transfusion related acute lung injury (TRALI) and transfusion associated circulatory overload (TACO), and how to distinguish between the two disorders.
An exceptionally clear review article by Brux and Sachs clarified the two-hit model of TRALI pathogenesis. The TRALI definition developed at the 2004 consensus conference helped demonstrate that TRALI is likely underreported. Brain natriuretic peptide can be useful in distinguishing cardiogenic from noncardiogenic pulmonary edema. Blood centers are implementing male predominant plasma programs to limit TRALI, and preliminary evidence suggests that this is a useful intervention.
TACO and TRALI have emerged as important causes of posttransfusion morbidity and mortality. As understanding of their pathogenesis improves, incidence, risk factors, differences, and possible preventive interventions are becoming clearer. There is no sentinel feature that distinguishes TRALI from TACO. Developing a thorough clinical profile including presenting signs and symptoms, fluid status, cardiac status including measurement of brain natriuretic peptide, and leukocyte antibody testing is the best strategy currently available to distinguish the two disorders.
本综述旨在概述近期文献中提出的影响我们对输血相关急性肺损伤（TRALI）和输血相关循环超负荷（TACO）理解的概念，以及如何区分这两种疾病。
Brux和Sachs撰写的一篇非常清晰的综述文章阐明了TRALI发病机制的双打击模型。2004年共识会议制定的TRALI定义有助于证明TRALI可能报告不足。脑钠肽有助于区分心源性肺水肿和非心源性肺水肿。血液中心正在实施以男性为主的血浆计划以限制TRALI，初步证据表明这是一种有用的干预措施。
TACO和TRALI已成为输血后发病和死亡的重要原因。随着对其发病机制的理解不断提高，发病率、危险因素、差异以及可能的预防干预措施正变得更加清晰。没有能够区分TRALI和TACO的标志性特征。制定全面的临床资料，包括出现的体征和症状、液体状态、心脏状态（包括脑钠肽测量）以及白细胞抗体检测，是目前区分这两种疾病的最佳策略。
