Quest Graeme R, Gaal Hilda, Clarke Gwen, Nahirniak Susan
Transfusion Medicine, Edmonton Zone, Alberta Health Services, Edmonton, Alberta, Canada; Laboratory Medicine and Pathology, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Transfusion. 2014 Dec;54(12):3088-91. doi: 10.1111/trf.12731. Epub 2014 Jun 5.
Transfusion-related acute lung injury (TRALI) is a severe transfusion reaction that manifests as acute respiratory compromise within 6 hours of the infusion of blood products. Intravenous immune globulin (IVIG) is prepared from large pools of human plasma and is commonly administered in the outpatient setting for the treatment of a wide range of diseases. As a plasma-derived blood product, IVIG may also cause TRALI, although reports of this are exceedingly rare.
A 77-year-old female with common variable immune deficiency had been receiving IVIG since 1996 for infection prophylaxis. During a scheduled infusion, the patient developed hypertension and dyspnea, requiring increasing oxygen supplementation and subsequent intubation. Radiographic studies demonstrated the bilateral chest infiltrates, with no evidence of infection or circulatory overload. The patient was extubated after 24 hours and discharged several days later. The patient had not previously received this lot of IVIG and has since received further transfusions with different lot numbers of the same product without incident.
This case report documents a case of TRALI after IVIG transfusion. While a very rare cause, this case furthers evidence that TRALI can occur after IVIG transfusion.
输血相关急性肺损伤（TRALI）是一种严重的输血反应，表现为输注血液制品后6小时内出现急性呼吸功能不全。静脉注射免疫球蛋白（IVIG）由大量人血浆制备而成，常用于门诊治疗多种疾病。作为一种血浆来源的血液制品，IVIG也可能导致TRALI，尽管此类报告极为罕见。
一名77岁患有常见可变免疫缺陷的女性自1996年以来一直接受IVIG预防感染。在一次 scheduled 输注期间，患者出现高血压和呼吸困难，需要增加氧气补充并随后进行插管。影像学研究显示双侧肺部浸润，无感染或循环超负荷的证据。患者在24小时后拔管，几天后出院。该患者此前未接受过此批次的IVIG，此后接受了不同批次同一产品的进一步输血，未发生意外。
本病例报告记录了一例IVIG输血后发生TRALI的病例。虽然是非常罕见的原因，但该病例进一步证明IVIG输血后可能发生TRALI。
