Schleicherk Kayla, Muzaffar Arshad, Tobias Joseph D
University of Missouri School of Medicine, Columbia, Missouri 43205, USA.
J Craniofac Surg. 2011 Jan;22(1):194-8. doi: 10.1097/SCS.0b013e3181f75446.
Transfusion-related acute lung injury (TRALI) is currently recognized by the US Food and Drug Administration as the number one cause of mortality related to blood transfusion. Although various pathophysiologic mechanisms have been proposed, it is thought to be related to the presence of anti-HLA antibodies or bioactive lipid components in the donor blood product, which results in activation of recipient leukocytes and the resultant pulmonary damage from the release of bioactive substances including cytokines. As TRALI manifests as acute lung injury with signs and symptoms consistent with acute respiratory distress syndrome, it is frequently underdiagnosed, as the acute lung injury may be attributed to other factors. Transfusion-related acute lung injury is an important clinical entity for anesthesia providers to recognize and diagnose accurately, as many transfusions occur in the surgical patient. We present a case report of a pediatric patient who developed intraoperative TRALI during calvarial vault remodeling to treat craniosynostosis. The history, pathophysiology, and treatment of TRALI are discussed. Potential preventive measures are reviewed.
输血相关急性肺损伤（TRALI）目前被美国食品药品监督管理局认定为与输血相关的首要死亡原因。尽管已经提出了各种病理生理机制，但人们认为它与供体血液制品中抗HLA抗体或生物活性脂质成分的存在有关，这会导致受者白细胞活化，并因包括细胞因子在内的生物活性物质释放而造成肺部损伤。由于TRALI表现为急性肺损伤，其体征和症状与急性呼吸窘迫综合征一致，因此常常被漏诊，因为急性肺损伤可能被归因于其他因素。输血相关急性肺损伤是麻醉医生需要准确识别和诊断的重要临床病症，因为许多手术患者都需要输血。我们报告一例小儿患者，其在颅骨重塑治疗颅缝早闭手术中发生术中TRALI。文中讨论了TRALI的病史、病理生理学和治疗方法。并回顾了潜在的预防措施。
