Moiz Bushra, Sharif Hasanat, Bawany Fauzia Ahmad
Department of Pathology and Microbiology, The Aga Khan University, Karachi.
J Pak Med Assoc. 2009 Jan;59(1):39-41.
Transfusion related acute lung injury (TRALI) is a life-threatening complication of transfusion of blood and its components resembling acute respiratory distress syndrome (ARDS) or acute lung injury (ALI). TRALI is a particular form of ARDS that follows blood transfusion and is caused by donor-derived antibodies present in the transfused products, reacting with the recipients' blood cells, inducing release of inflammatory mediators thus compromising lung functions. Anti-HLA antibodies are the most frequently indicted inducers in this category. Literature search has not revealed any documented case of TRALI from Pakistan. This in no way implies that TRALI is non existent in this part of the world but rather indicates that many clinicians may be unaware of the condition or may not recognize transfusion as the cause and like in other parts of the world, is almost certainly under-diagnosed. The lack of agreement on the definite cellular and molecular mechanisms underlying the development of TRALI renders the task of improving the safety of blood transfusion far more complex and potentially quite expensive. This review discusses the modern concepts of pathogenesis of TRALI along with its clinicopathological manifestations and management with the aim to improve awareness of our clinicians towards this dreadful and potentially fatal condition.
输血相关急性肺损伤（TRALI）是输血及其成分时出现的一种危及生命的并发症，类似于急性呼吸窘迫综合征（ARDS）或急性肺损伤（ALI）。TRALI是输血后发生的一种特殊形式的ARDS，由输注产品中存在的供体来源抗体与受者血细胞反应引起，诱导炎症介质释放，从而损害肺功能。抗HLA抗体是此类中最常被提及的诱导因素。文献检索未发现来自巴基斯坦的TRALI病例记录。这绝不意味着TRALI在世界的这一地区不存在，而是表明许多临床医生可能不了解这种情况，或者可能没有认识到输血是病因，并且与世界其他地区一样，几乎肯定存在诊断不足的情况。关于TRALI发生的确切细胞和分子机制缺乏共识，使得提高输血安全性的任务更加复杂，而且可能相当昂贵。本综述讨论了TRALI发病机制的现代概念及其临床病理表现和管理，旨在提高我们临床医生对这种可怕且可能致命疾病的认识。
