Citations 2
Recipient clinical risk factors predominate in possible transfusion‐related acute lung injury
Toy, Pearl, Bacchetti, Peter , Grimes, Barbara , Murphy, Edward L. , Gropper, Michael A. , Hubmayr, Rolf D., Matthay, Michael A. , Wilson, Gregory , Koenigsberg, Monique, Lee, Deanna C., Hirschler, Nora V., Lowell, Clifford A. , Schuller, Randy M. , Norris, Philip J. , Mair, David , Rosen, Rosa Sanchez, Looney, Mark R. , Winters, Jeffrey L. , Gajic, Ognjen , Gandhi, Manish J.
Transfusion | December 13, 2014 | Volume: 55 | Issue: 5 | Pages: 947-952
Background Possible transfusion‐related acute lung injury (p TRALI ) cases by definition have a clear temporal relationship to an alternative recipient risk factor for acute respiratory distress syndrome ( ARDS ). We questioned whether transfusion factors are important for the development of p TRALI . Study Design and Methods In this nested case‐control study, we prospectively identified 145 consecutive patients with p TRALI and randomly selected 163 transfused controls over a 4‐year period at the U niversity of C alifornia at S an F rancisco and the M ayo C linic ( R ochester, M innesota). Results For p TRALI , we found evidence against transfusion being important: receipt of plasma from female donors (odds ratio [ OR ], 0.82; 95% confidence interval [ CI ], 0.29‐2.3; p = 0.70), total number of units transfused ( OR , 0.99; 95% CI , 0.89‐1.10; p = 0.86), and number of red blood cell and whole blood units transfused ( OR , 0.78; 95% CI , 0.59‐1.03; p = 0.079). In contrast, we found that risk for p TRALI was associated with additional recipient factors: chronic alcohol abuse ( OR , 12.5; 95% CI , 2.8‐55; p < 0.001), current smoker ( OR , 4.2; 95% CI , 1.67‐10.8; p = 0.0024), shock before transfusion ( OR , 4.6; 95% CI , 2.0‐10.7; p < 0.001), and positive fluid balance before transfusion ( OR , 1.32/ L ; 95% CI , 1.20‐1.44; p < 0.001). Conclusion Recipient risk factors for ARDS rather than transfusion risk factors predominate in p TRALI .
Transfusion-related acute lung injury: incidence and risk factors
Toy, Pearl, Bacchetti, Peter , Looney, Mark R. , Gropper, Michael A. , Hubmayr, Rolf D., Lowell, Clifford A. , Norris, Philip J. , Murphy, Edward L. , Weiskopf, Richard B. , Wilson, Gregory , Koenigsberg, Monique, Lee, Deanna, Schuller, Randy M. , Wu, Ping , Grimes, Barbara , Winters, Jeffrey L. , Mair, David , Hirschler, Nora V., Rosen, Rosa Sanchez, Matthay, Michael A. , Group, for the TRALI Study, Gajic, Ognjen , Gandhi, Manish J. , Group, for the TRALI Study, Winters, Jeffrey L
Blood | November 24, 2011 | Volume: 119 | Issue: 7 | Pages: 1757-1767
AbstractTransfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality. To determine TRALI incidence by prospective, active surveillance and to identify risk factors by a case-control study, 2 academic medical centers enrolled 89 cases and 164 transfused controls. Recipient risk factors identified by multivariate analysis were higher IL-8 levels, liver surgery, chronic alcohol abuse, shock, higher peak airway pressure while being mechanically ventilated, current smoking, and positive fluid balance. Transfusion risk factors were receipt of plasma or whole blood from female donors (odds ratio = 4.5, 95% confidence interval [CI], 1.85-11.2, P = .001), volume of HLA class II antibody with normalized background ratio more than 27.5 (OR = 1.92/100 mL, 95% CI, 1.08-3.4, P = .03), and volume of anti–human neutrophil antigen positive by granulocyte immunofluoresence test (OR = 1.71/100 mL, 95% CI, 1.18-2.5, P = .004). Little or no risk was associated with older red blood cell units, noncognate or weak cognate class II antibody, or class I antibody. Reduced transfusion of plasma from female donors was concurrent with reduced TRALI incidence: 2.57 (95% CI, 1.72-3.86) in 2006 versus 0.81 (95% CI, 0.44-1.49) in 2009 per 10 000 transfused units (P = .002). The identified risk factors provide potential targets for reducing residual TRALI.