Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Academic Medical Center, Room G3-206, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Expert Rev Hematol. 2010 Aug;3(4):459-67. doi: 10.1586/ehm.10.41.
Recent insights from models of transfusion-related acute lung injury (TRALI), and from clinical reports, reveal that host factors are important in TRALI pathogenesis. Predisposing factors with lung neutrophil-priming capacity, such as sepsis and mechanical ventilation, increase susceptibility for a TRALI reaction, and can aggravate the course of disease. These findings may explain the higher incidence of TRALI in the critically ill compared with general hospital populations. The emerging importance of host factors may have implications for TRALI management. Suspected TRALI cases in which another acute lung injury risk factor is present (termed 'possible TRALI' in the consensus definition) should be reported to the blood bank, including patients suffering from an underlying condition. In reporting of TRALI cases, use of the international TRALI consensus definition should be used, rather then national TRALI scoring systems, to ensure a uniform approach, which may decrease variance in estimations of incidence. In terms of treatment of TRALI patients, there is a rationale to apply therapeutic strategies, which have proven to be beneficial in acute lung injury.
近期，通过对输血相关急性肺损伤（TRALI）模型和临床报告的深入研究，揭示了宿主因素在 TRALI 发病机制中的重要性。具有肺中性粒细胞预激活能力的易感因素，如脓毒症和机械通气，会增加发生 TRALI 反应的易感性，并可能加重疾病进程。这些发现可能解释了与一般医院人群相比，危重病患者中 TRALI 的发生率更高的原因。宿主因素的重要性日益凸显，可能对 TRALI 的治疗管理产生影响。对于存在其他急性肺损伤风险因素的疑似 TRALI 病例（在共识定义中称为“可能的 TRALI”），应向血库报告，包括患有基础疾病的患者。在 TRALI 病例报告中，应使用国际 TRALI 共识定义，而不是国家 TRALI 评分系统，以确保采用统一的方法，这可能会降低发病率估计值的差异。在 TRALI 患者的治疗方面，应用已被证明对急性肺损伤有益的治疗策略具有一定的合理性。
