Transfusion-Related Acute Lung Injury

Immediately stop the transfusion when dyspnea, hypoxemia, hypotension, fever, or new pulmonary edema develops during infusion or within 6 hours after completion. Maintain access as clinically necessary, increase oxygen delivery, obtain a portable chest radiograph when respiratory status worsens, and notify the transfusion service. PubMed+2PubMedA consensus redefinition of transfusion‐related acute lung injurycdn clinicaltrialsVersion 4.0 Serial #0002 1 06/19/2020 Study Protocol and ...ScienceDirectAcute Hemolytic Transfusion Reaction - an overview

Stabilize oxygenation before assigning a reaction subtype. Use supplemental oxygen for less severe hypoxemia; provide mechanical ventilatory support when oxygenation or work of breathing requires it. TRALI management is supportive and parallels management of permeability pulmonary edema; low-pressure, low-tidal-volume ventilation is described to reduce ventilator-associated barotrauma risk. ScienceDirect+2ScienceDirectTransfusion-Related Acute Lung InjuryPubMedTransfusion-related acute lung injury (TRALI): Current Concepts and MisconceptionsScienceDirectAcute Hemolytic Transfusion Reaction - an overview

Do not administer empiric diuretics solely because the radiograph shows edema. Diuretics may reduce intravascular volume in TRALI and are not indicated for isolated permeability edema; reserve respiratory support plus diuresis for a clinical picture supporting TACO or a mixed TRALI-TACO process. PubMed+1PubMedTransfusion-related acute lung injury (TRALI): Current Concepts and MisconceptionsScienceDirectAcute Hemolytic Transfusion Reaction - an overview

Diagnose TRALI clinically rather than by a single confirmatory assay. The core syndrome is acute hypoxemia with bilateral pulmonary edema during or within 6 hours of transfusion, without substantial left atrial hypertension. Hypoxemia may be defined by a PaO2/FiO2 ratio of 300 or less or oxygen saturation below 90% on room air. PubMed+1PubMedA consensus redefinition of transfusion‐related acute lung injuryPubMedTransfusion-Related Acute Lung Injury - StatPearls - NCBI Bookshelf

Classify TRALI type I when the patient fulfills posttransfusion pulmonary edema criteria and has no ARDS risk factor. Sepsis, pneumonia, aspiration, shock, and similar acute lung-injury risks must trigger a competing ARDS assessment rather than automatic type I classification. Wiley+2WileyA consensus redefinition of transfusion‐related acute lung injury - Vlaar - 2019 - Transfusion - Wiley Online LibraryPubMedTransfusion-Related Acute Lung Injury - StatPearls - NCBI BookshelfASHHow I diagnose and treat cardiorespiratory complications of ...

Classify TRALI type II only when an ARDS risk factor or mild ARDS is present, the posttransfusion event otherwise meets type I criteria, and pulmonary status was stable during the preceding 12 hours, including stability assessed by PaO2/FiO2 ratio. A declining oxygenation trajectory before transfusion instead supports ARDS progression. Wiley+1WileyA consensus redefinition of transfusion‐related acute lung injury - Vlaar - 2019 - Transfusion - Wiley Online LibraryPubMedA consensus redefinition of transfusion‐related acute lung injury

Do not require a pulmonary artery wedge pressure measurement or PEEP above 5 cm H2O to make the diagnosis. In contemporary practice, assess for left atrial hypertension using clinical evidence and available cardiac or volume-status data; BNP alone has uncertain ability to distinguish ARDS from cardiogenic edema. PubMed+2PubMedA consensus redefinition of transfusion‐related acute lung injuryPubMedRisk factors, management and prevention of transfusion-related acute lung injury: a comprehensive updateScienceDirectNoncardiogenic Lung Edema - an overview | ScienceDirect Topics

Prioritize TACO when pulmonary edema follows a large-volume or rapid infusion in a patient with left ventricular dysfunction, renal impairment, positive fluid balance, severe anemia, or advanced age. Orthopnea, hypertension, peripheral edema, cardiomegaly, and clinical volume overload favor TACO; respiratory support and diuresis are the principal therapeutic interventions. ScienceDirect+1ScienceDirectAcute Hemolytic Transfusion Reaction - an overviewScienceDirectBlood Group Incompatibility - an overview

Favor TRALI when the dominant pattern is abrupt, profound hypoxemia with bilateral infiltrates, fever, hypotension, and no convincing pulmonary vascular overload. Both syndromes can occur simultaneously, so a patient with partial volume overload features should not be excluded from TRALI evaluation or donor investigation. ScienceDirect+2ScienceDirectTransfusion Related Acute Lung Injury - an overviewASHApproach to the Diagnosis and Management of Transfusion-Related Acute Lung Injury | The Hematologist | American Society of HematologyScienceDirectAcute Hemolytic Transfusion Reaction - an overview

Evaluate anaphylaxis when respiratory distress occurs with an acute allergic phenotype; acute hemolytic and febrile nonhemolytic reactions remain competing transfusion reactions. Evaluate sepsis, aspiration, pneumonia, and shock as alternative ARDS drivers, particularly when the patient had respiratory compromise before transfusion. ASH+2ASHApproach to the Diagnosis and Management of Transfusion-Related Acute Lung Injury | The Hematologist | American Society of Hematologycdn clinicaltrialsVersion 4.0 Serial #0002 1 06/19/2020 Study Protocol and ...PubMedTransfusion-Related Acute Lung Injury - StatPearls - NCBI Bookshelf

Supportive respiratory care is the treatment for TRALI. Escalate from supplemental oxygen to mechanical ventilation when hypoxemia or respiratory distress warrants it, and use ventilator pressures and tidal volumes intended to avoid barotrauma. ScienceDirect+2ScienceDirectTransfusion-Related Acute Lung InjuryPubMedTransfusion-related acute lung injury (TRALI): Current Concepts and MisconceptionsScienceDirectAcute Hemolytic Transfusion Reaction - an overview

Monitor serial oxygen requirement, pulse oximetry, hemodynamics, fluid balance, and chest imaging as clinically indicated. Most patients described in clinical summaries recover within 48 to 96 hours; persistent or worsening pulmonary failure should prompt renewed evaluation for ARDS, sepsis, aspiration, cardiac dysfunction, or a mixed reaction. ScienceDirect+1ScienceDirectAcute Hemolytic Transfusion Reaction - an overviewScienceDirectBlood Group Incompatibility - an overview

Avoid interpreting a response to diuresis as definitive proof of TACO. Because TRALI and TACO may coexist, reassess volume status and oxygenation after interventions rather than forcing a single diagnosis in a patient with discordant findings. ASH+1ASHApproach to the Diagnosis and Management of Transfusion-Related Acute Lung Injury | The Hematologist | American Society of HematologyScienceDirectAcute Hemolytic Transfusion Reaction - an overview

Report all suspected pulmonary transfusion reactions to the transfusion service promptly. Potential TRALI reactions warrant donor investigation because donor blood products may cause additional cases; blood centers can contact and evaluate implicated donors. Oxford Academic+2Oxford AcademicPathology Consultation on Transfusion-Related Acute Lung ...ScienceDirectAcute Hemolytic Transfusion Reaction - an overviewScienceDirectBlood Group Incompatibility - an overview

Donor-derived HLA class I, HLA class II, and HNA antibodies are major mechanisms, although TRALI can occur without detectable HLA or HNA antibodies. Consequently, absence of an identified antibody should not overturn a clinically appropriate TRALI classification. Oxford Academic+2Oxford AcademicPathology Consultation on Transfusion-Related Acute ...Oxford AcademicPathology Consultation on Transfusion-Related Acute Lung ...ASHSpotlight on pathogenesis of TRALI: HNA-3a (CTL2) antibodies | Blood | American Society of Hematology

Risk-reduction strategies target plasma exposure and donor alloimmunization. Plasma from previously pregnant donors has been associated with TRALI risk, and male-only plasma was associated with a 68% reduction in TRALI risk across transfused units from 2006 to 2009. Solvent-detergent plasma has been reported to eliminate TRALI risk. ASH+1ASHSpotlight on pathogenesis of TRALI: HNA-3a (CTL2) antibodies | Blood | American Society of HematologyPubMedTACO and TRALI: biology, risk factors, and prevention strategies - PMC

For future transfusions, communicate the prior reaction to the transfusion service and reassess the indication for each component. A prior recipient episode does not itself establish heightened susceptibility to another TRALI episode when the original event was caused by antibodies in a specific donor product, but implicated donor products require restriction. ASH+1ASHApproach to the Diagnosis and Management of Transfusion-Related Acute Lung Injury | The Hematologist | American Society of HematologyScienceDirectAcute Hemolytic Transfusion Reaction - an overview