The incidence, risk factors and outcome of transfusion-related acute lung injury in a cohort of cardiac surgery patients: a prospective nested case control study.
Blood. 2011 Feb 16;
Authors: Vlaar AP, Hofstra JJ, Determann RM, Veelo DP, Paulus F, Kulik W, Korevaar J, de Mol BA, Koopman MM, Porcelijn L, Binnekade JM, Vroom MB, Schultz MJ, Juffermans NP
Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related morbidity and mortality. Both antibodies and bio-active lipids that have accumulated during storage of blood have been implicated in TRALI pathogenesis. In a single center nested case control study, patients were prospectively observed for onset of TRALI according to the consensus definition. Of 668 patients, 16 patients developed TRALI (2.4%). Patient-related risk factors for onset of TRALI were age and time on the cardiopulmonary bypass. Transfusion-related risk factors were total amount of blood products [OR1.2 (1.03-1.44)], number of red blood cells stored > 14 days [OR1.6 (1.04-2.37)], total amount of plasma [OR1.2 (1.03-1.44)], presence of antibodies in donor plasma [OR8.8 (1.8-44)] and total amount of transfused bio-active lipids [OR1.0 (1.00-1.07)]. When adjusted for patient risk factors, only the presence of antibodies in the associated blood products remained a risk factor for TRALI [OR14.2 (1.5-132)]. In-hospital mortality of TRALI was 13% compared to 0% and 3% in transfused and non-transfused patients (p<0.05). In conclusion, the incidence of TRALI is high in cardiac surgery patients and associated with adverse outcome. Our results suggest that cardiac surgery patients may benefit from exclusion of blood products containing HLA/HNA antibodies.
PMID: 21325598 [PubMed - as supplied by publisher]