Transfused related acute lung injury

Table of Contents

Transfused Related Acute Lung Injury is a clinical condition by which excessive blood or blood products accumulate in the lungs leading to lower oxygen in the lungs and body. 

Transfusion-related lung injury was first discovered in the 1950s then later it was recognized as a clinical syndrome.  It can diagnose as clinical as well as radio graphics techniques. Its symptoms appear within 6 hours. [1]Microsoft Word – INF271.doc (windows.net)

Below some risk factors 

  •         Sepsis from pneumonia
  •         Sepsis from aspiration
  •         Sepsis from shock

Some physical symptoms are given below

  •         Fever
  •         Hypotension
  •         Tachycardia

Patients who suffer from hypotension also with acute dyspnea (it is a shortness of breath or it may be called ‘’air hunger ‘’) that patients required more oxygen via nasal cannula. But due to the accumulation of fluid in the lungs, it is very difficult to breathe. 

Etiology 

According to diagnostic criteria for a patient, TRALI does not have any endangered factors for lung injury. TRALI mainly occurs due to harm to the central nervous system such as pulmonary vasculature. It damages the central nervous system from neutrophil-mediated. It occurs in the form of a human neutrophil antigen.

The antibodies in donor blood present in the human body bind with a serum-containing protein called antigen of the recipient. The product storage in the blood can assemble the proinflammatory mediators that are the main cause of TRALI. A hypothesis is put in an application in this clinical syndrome.

The folds of neutrophil called neutrophil sequestration may occur in pulmonary vasculature the neutrophil present in the blood harms the endothelial layer that results in leakage of protein and fluid into the alveolar space. [2]Transfusion-related Acute Lung Injury – StatPearls – NCBI Bookshelf (nih.gov)

Epidemiology 

 There is some risk factor that results in TRALI such as

  •         Mechanical ventilation
  •         Sepsis
  •         Massive transfusion
  •         Coronary artery bypass
  •         End-stage liver disease

Causes 

The main reason for this disease is not well known. It is assumed that 80-85% are immune-mediated. Antibodies straight in the direction of human white blood cells antigen or may with the neutrophil antigen of human.

Those women who develop more than two babies produce these antibodies to destroy the blood of the fetal. The migration of blood compartments that are taken from donors has a high risk of increasing immune-mediated TRALI.

The process of the transfusion that occurs before this has become the cause of sensitization of the donor. That has a high risk of TRALI during this type of mechanism.

In this case, blood exposes the receptors of neutrophils and a special type of HLA. TRALI is linked with special products of plasma that like Palmerian association of blood group suggested at  that blood plasma is used for making a high volume of blood plasma component instead of transfusion because it has a high risk of TRALI. 

Prognosis and prevention

The rate of death is approximately 5-10%.  TRALI can influence 47% that is closely linked with mortality on 90 days. The long-standing role of pulmonary in the TRALI is that the stayer from TRAIL seemed in a similar situation of that patient that never suffer from TRALI and no symptoms are shown such as fibrosis or destruction of any structure of lung parenchyma that was becoming the main cause of TRALI. 

The treatment of TRALI is that the patient who suffers recommended fast resolution of hypoxemia that time zone range is approximately 2 days. [3]Transfusion-related acute lung injury (TRALI) – UpToDate

Written by: Dr. Muhammad Mohsin Ahsan

Reviewed by:
Dr. Shafaat Yar Khan  (Ph.D.) 
Medical University of Vienna, Austria 
Present: University of Sargodha, Pakistan

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