输血相关急性肺损伤（TRALI）：澳大利亚昆士兰州 20 多年来报告病例的回顾性研究。
Transfusion-related acute lung injury (TRALI): a retrospective review of reported cases in Queensland, Australia over 20 years.
机构信息
Clinical Services and Research, Australian Red Cross Lifeblood, Australia.
Faculty of Medicine, University of Queensland, Brisbane, Australia.
出版信息
Blood Transfus. 2022 Nov;20(6):454-464. doi: 10.2450/2022.0020-22. Epub 2022 Jun 24.
BACKGROUND
Transfusion-related acute lung injury (TRALI) is a rare but potentially fatal transfusion reaction. An effective haemovigilance programme is important in implementing successful and targeted risk reduction strategies. We aim to provide a summary of TRALI cases referred for investigation in Queensland (QLD) Australia from 1999 to 2019, describing the epidemiological and laboratory features of local TRALI cases.
MATERIALS AND METHODS
A retrospective audit evaluated all cases reported to the QLD Australian Red Cross Lifeblood over the 20-year study period. Cases were categorised according to the 2004 Canadian consensus criteria.
RESULTS
Of the 91 cases referred for investigation, expert review confirmed 30 of TRALI and 18 of possible TRALI. A total of 238 donors and 110 blood products were assessed in confirmed cases. TRALI affected patients of all ages. Most patients had underlying haematological malignancies (25%), surgery (15%) or liver disease (13%). TRALI incidence was measured at 1 in 130,000 per issued product in QLD. Red cells were transfused in 32 cases, platelets in 18 and plasma products in 21, with 16 cases involving multiple products. Following laboratory assessment, 23% of cases had findings supportive of antibody mediated TRALI and 21% as likely non-antibody mediated. Possible TRALI was identified in 37.5% of cases of which 25% were antibody mediated and 12.5% non-antibody mediated. Nine (18.5%) cases were uncategorised due to insufficient immunologic investigations.
DISCUSSION
Rates of TRALI incidence measured are lower than those seen in many international studies. A reduction in confirmed cases has been noted over recent years, supporting the implementation of risk-reduction strategies. We report a relatively higher proportion of non-antibody mediated TRALI and possible TRALI cases in more recent years, suggesting the need to further understand the role of product age and biological risk modifiers.
背景
输血相关急性肺损伤（TRALI）是一种罕见但潜在致命的输血反应。有效的血液监测计划对于实施成功和有针对性的降低风险策略非常重要。我们旨在提供澳大利亚昆士兰州（QLD）1999 年至 2019 年期间TRALI 调查转介病例的摘要，描述当地 TRALI 病例的流行病学和实验室特征。
材料和方法
回顾性审核评估了在 20 年研究期间向澳大利亚红十字会生命血库报告的所有病例。根据 2004 年加拿大共识标准对病例进行分类。
结果
在转介调查的 91 例病例中，专家审查确认了 30 例 TRALI 和 18 例可能的 TRALI。在确诊病例中评估了 238 名供体和 110 个血液制品。TRALI 影响所有年龄段的患者。大多数患者患有基础血液病（25%）、手术（15%）或肝脏疾病（13%）。在 QLD，TRALI 的发病率为每 13 万份产品中 1 例。32 例输注红细胞，18 例输注血小板，21 例输注血浆制品，16 例涉及多种产品。经过实验室评估，23%的病例有支持抗体介导 TRALI 的发现，21%的病例可能是非抗体介导的。37.5%的病例被确定为可能的 TRALI，其中 25%为抗体介导，12.5%为非抗体介导。由于免疫检查不足，9 例（18.5%）病例未分类。
讨论
测量的 TRALI 发病率低于许多国际研究中的发病率。近年来，确诊病例数量有所减少，这支持了降低风险策略的实施。我们报告了近年来非抗体介导的 TRALI 和可能的 TRALI 病例比例相对较高，这表明需要进一步了解产品年龄和生物学风险修饰物的作用。
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