Camara-Lemarroy Carlos R
Departamento de Medicina Interna, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey, NL 64460, Mexico.
Med Hypotheses. 2014 Sep;83(3):273-5. doi: 10.1016/j.mehy.2014.05.016. Epub 2014 Jun 7.
Transfusion-related acute lung injury (TRALI) is a serious complication of transfusion medicine, considered now as the leading cause of transfusion-related mortality. It may occur in up to 1 in 5000 transfusions and carries an elevated morbidity and mortality. Clinically it presents as hypoxia and non-cardiogenic pulmonary edema, usually within 6h of transfusion. It consists of an immunological phenomenon involving the activation of neutrophils and endothelial injury, leading to capillary leak and pulmonary edema, mechanisms shared with lung ischemia-reperfusion (IR) injury. Brief and repetitive periods of ischemia in an organ or limb have been shown to protect against subsequent major IR injury in distant organs, a phenomenon called remote ischemic preconditioning (RIPC). Limb RIP has been shown to protect the lung against IR injury trough modulation of endothelial function as well as neutrophil activation and infiltration. The protective effects of RIPC on the lung have been confirmed in clinical trials of orthopedic and cardiothoracic surgery. RIPC is a safe, tolerable and cheap procedure. I propose that limb RIPC could be used as a preventive strategy against the development of TRALI.
输血相关急性肺损伤（TRALI）是输血医学中的一种严重并发症，现在被认为是输血相关死亡的主要原因。它可能在每5000次输血中发生1例，并且具有较高的发病率和死亡率。临床上，它通常在输血后6小时内表现为缺氧和非心源性肺水肿。它是一种免疫现象，涉及中性粒细胞的激活和内皮损伤，导致毛细血管渗漏和肺水肿，这与肺缺血再灌注（IR）损伤有共同机制。器官或肢体的短暂反复缺血已被证明可预防远处器官随后发生的严重IR损伤，这种现象称为远程缺血预处理（RIPC）。肢体RIPC已被证明可通过调节内皮功能以及中性粒细胞的激活和浸润来保护肺免受IR损伤。RIPC对肺的保护作用已在骨科和心胸外科的临床试验中得到证实。RIPC是一种安全、可耐受且廉价的方法。我建议肢体RIPC可作为预防TRALI发生的一种策略。
