Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Transfusion. 2022 Mar;62(3):594-599. doi: 10.1111/trf.16822. Epub 2022 Feb 17.
Antibody-mediated transfusion-related acute lung injury (TRALI) is caused by donor HLA or HNA antibodies in plasma-containing products. In the Netherlands 55,000 units of solvent/detergent plasma (SDP), a pooled plasma product, are transfused yearly. It's produced by combining plasma from hundreds of donors, diluting harmful antibodies. Due to a lack of reported cases following implementation, some have labeled SDP as "TRALI safe".
Pulmonary transfusion reactions involving SDP reported to the Dutch national hemovigilance network in 2016-2019 were reviewed. Reporting hospitals were contacted for additional information, cases with TRALI and imputability definite, probable, or possible were included and informed consent was sought.
A total of three TRALI and nine TACO cases were reported involving SDP. The imputability of one TRALI case was revised from possible to unlikely and excluded; in one case no informed consent was obtained. We present a case description of TRALI following SDP transfusion in a 69-year-old male, 3 days following endovascular aortic aneurysm repair. The patient received one unit of SDP to correct a heparin-induced coagulopathy, prior to removal of a spinal catheter post-operatively. Within five hours he developed hypoxemic respiratory failure requiring intubation, hypotension, bilateral chest infiltrates, and leucopenia. The patient made a full recovery.
This case of TRALI, following transfusion of a single unit of SDP to a patient without ARDS risk factors, demonstrates that TRALI can occur with this product. Clinicians should remain vigilant and continue to report suspected cases, to help further understanding of SDP-associated TRALI.
抗体介导的输血相关性急性肺损伤（TRALI）是由血浆制品中的供体 HLA 或 HNA 抗体引起的。在荷兰，每年输注 55000 单位溶剂/去污剂血浆（SDP），这是一种混合血浆产品，通过合并来自数百名供体的血浆来稀释有害抗体。由于实施后缺乏报告病例，有人将 SDP 标记为“TRALI 安全”。
对 2016 年至 2019 年向荷兰全国血液监测网络报告的涉及 SDP 的肺部输血反应进行了回顾。与报告医院联系以获取更多信息，包括 TRALI 和可归因性明确、可能或可能的病例，并征求了知情同意。
共报告了三例 SDP 相关的 TRALI 和九例 TACO 病例。一例 TRALI 病例的可归因性从可能改为不太可能，并被排除；在一例病例中，未获得知情同意。我们报告了一例 69 岁男性在血管内主动脉瘤修复后 3 天接受 SDP 输血后发生 TRALI 的病例。该患者在手术后移除脊髓导管前因肝素诱导的凝血障碍接受了 1 单位 SDP。五小时内，他出现低氧性呼吸衰竭，需要插管，低血压，双侧胸部浸润和白细胞减少。患者完全康复。
本例 TRALI 是在没有 ARDS 危险因素的患者输注 1 单位 SDP 后发生的，表明该产品可发生 TRALI。临床医生应保持警惕，并继续报告疑似病例，以帮助进一步了解 SDP 相关的 TRALI。
