Yanagisawa Ryu, Abe Seiki, Fujihara Ikuko, Komori Kazutoshi, Kondo Yoshiaki, Sakashita Kazuo, Nakamura Tomohiko
Life Science Research Center, Nagano Children's Hospital, Azumino, Japan; Division of Blood Transfusion, Shinshu University Hospital, Matsumoto, Japan; Center for Advanced Cell Therapy, Shinshu University Hospital, Matsumoto, Japan.
Department of Anesthesia, Nagano Children's Hospital, Azumino, Japan.
Transfus Apher Sci. 2017 Oct;56(5):744-747. doi: 10.1016/j.transci.2017.09.003. Epub 2017 Sep 20.
Although several types of transfusion-related adverse reactions (TRARs) have been reported, one of the most important involves respiratory features during and after blood transfusion. Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are the most severe adverse events following blood transfusion, whereas transfusion-associated dyspnea (TAD) is a less severe respiratory distress. However, there exists little evidence of these factors in pediatric populations.
Here, two cases of atypical TRARs with respiratory features, in pediatric patients with solid tumors, appearing after transfusion of platelet concentrate following autologous peripheral blood stem cell transplantation are reported. Both patients developed mild hypoxemia during PC transfusion, which continued for approximately 2 weeks. Chest radiography in either patient did not reveal any abnormalities that are included in the criteria of either TRALI or TACO. Both patients recovered following oxygen administration.
This complication of TRARs with respiratory features may occur more frequently in pediatric populations than realized because it may be under-recognized or under-reported. Accumulation of additional cases, including non-typical cases, is necessary to fully understand the pathology of TRARs, correctly classify these reactions, and improve care of patients receiving blood transfusions.
尽管已报告了几种类型的输血相关不良反应（TRARs），但其中最重要的一种涉及输血期间及输血后的呼吸系统特征。输血相关急性肺损伤（TRALI）和输血相关循环超负荷（TACO）是输血后最严重的不良事件，而输血相关呼吸困难（TAD）是一种较轻的呼吸窘迫。然而，在儿科人群中，关于这些因素的证据很少。
本文报告了两例实体瘤儿科患者在自体外周血干细胞移植后输注血小板浓缩液后出现的具有呼吸系统特征的非典型TRARs病例。两名患者在输注血小板浓缩液期间均出现轻度低氧血症，并持续约2周。两名患者的胸部X线检查均未发现符合TRALI或TACO标准的任何异常。两名患者经吸氧后均康复。
这种具有呼吸系统特征的TRARs并发症在儿科人群中可能比我们意识到的更频繁地发生，因为它可能未得到充分认识或报告不足。需要积累更多病例，包括非典型病例，以充分了解TRARs的病理，正确分类这些反应，并改善接受输血患者的护理。
