Vlaar A P, Schultz M J, Juffermans N P
Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Centre, Amsterdam, the Netherlands.
Neth J Med. 2009 Nov;67(10):320-6.
Two decades ago, transfusion-related acute lung injury (TRALI) was considered a rare complication of transfusion medicine. Nowadays, TRALI has emerged as the leading cause of transfusion-related mortality, presumably as a consequence of reaching international agreement on defining TRALI with subsequent increased recognition and reporting of TRALI cases. Specific patient populations such as critically ill patients have an increased risk of developing TRALI, which may be explained by the two-event hypothesis. The first event is the underlying condition of the patient resulting in priming of neutrophils. The second event is the transfusion of a blood product, after which either antibodies or bioactive lipids activate the primed neutrophils, resulting in pulmonary oedema. As opposed to the traditional view that TRALI has a good prognosis, TRALI may have a significant impact on morbidity and outcome, at least in specific patient groups. The association of transfusion with adverse outcome calls for blood product and donor management strategies aimed at decreasing the risk of acquiring TRALI. Excluding female donors from plasma donation seems to have reduced, but not prevented the occurrence of TRALI . Additional research is needed to determine whether the use of fresh blood products may be an additional measure to reduce TRALI. Studies are also needed to identify at-risk patients. In these studies, we advocate the use of the consensus definition to improve comparability of risk factors and outcome of TRALI across patient populations.
二十年前，输血相关急性肺损伤（TRALI）被认为是输血医学中一种罕见的并发症。如今，TRALI已成为输血相关死亡的主要原因，这大概是由于在TRALI定义上达成了国际共识，随后对TRALI病例的认识和报告有所增加。特定患者群体，如重症患者，发生TRALI的风险增加，这可能由双事件假说解释。第一个事件是患者的基础疾病导致中性粒细胞预激活。第二个事件是输注血液制品，之后抗体或生物活性脂质激活预激活的中性粒细胞，导致肺水肿。与传统观点认为TRALI预后良好相反，TRALI可能对发病率和结局有重大影响，至少在特定患者群体中如此。输血与不良结局的关联要求采取旨在降低发生TRALI风险的血液制品和献血者管理策略。排除女性献血者捐献血浆似乎减少了但并未防止TRALI的发生。需要进一步研究以确定使用新鲜血液制品是否可能是降低TRALI的一项额外措施。还需要开展研究以识别高危患者。在这些研究中，我们提倡使用共识定义来提高不同患者群体中TRALI危险因素和结局的可比性。
