Okazaki Hitoshi
Japanese Red Cross Society, Blood Service Headquarters, Central Blood Institute, Koto-ku, Tokyo 135-8521, Japan.
Rinsho Byori. 2013 May;61(5):399-406.
In recent years, much attention has been paid to respiratory complications of transfusion. Transfusion related acute lung injury (TRALI) is defined as an acute lung injury that is temporally associated with blood transfusion. TRALI is one of the leading causes of mortality. Although the etiology of TRALI is not fully understood, one of its main causes is thought to be anti-leukocyte antibodies, such as HLA antibody or HNA antibody. A precautionary male-predominant plasma strategy has been implemented in many developed countries, which has resulted in considerable achievements in reducing the incidence of TRALI. Meanwhile, transfusion-associated circulatory overload (TACO) has emerged as a major differential diagnosis of TRALI. TACO is a well-known complication of transfusion, which has been considered not as a side effect of transfusion but a result of erroneous medical practice. It has long been an under-reported complication of transfusion and has not been investigated scientifically. Recent data on transfusion mortality from the Food and Drug Administration revealed that TACO was the second highest cause of death in the United States. Our data also suggested a steep increase in the reported cases of TACO in Japan. Precautionary measures should also be implemented for this emerging complication.
近年来，输血的呼吸系统并发症受到了广泛关注。输血相关急性肺损伤（TRALI）被定义为一种与输血在时间上相关的急性肺损伤。TRALI是主要的死亡原因之一。尽管TRALI的病因尚未完全明确，但其主要原因之一被认为是抗白细胞抗体，如HLA抗体或HNA抗体。许多发达国家已实施以男性为主的血浆预防策略，在降低TRALI发病率方面取得了显著成效。与此同时，输血相关循环超负荷（TACO）已成为TRALI的主要鉴别诊断。TACO是一种众所周知的输血并发症，一直被认为不是输血的副作用，而是错误医疗行为的结果。长期以来，它一直是一种报告不足的输血并发症，尚未得到科学研究。美国食品药品监督管理局关于输血死亡率的最新数据显示，TACO是美国第二大死亡原因。我们的数据也表明，日本报告的TACO病例数急剧增加。对于这种新出现的并发症也应采取预防措施。
