Acute lung injury that develops within 6 hours after transfusion of 1 or more units of blood or blood components.
Increased risk with greater number of transfusions
Incidence is 1 in 4000
Definition
Acute onset
Hypoxemia (PaO2/FiO2 < 300 mm Hg)
Bilateral pulmonary opacities on chest x-ray
Absence of left atrial hypertension
Pathogenesis
Two-hit hypothesis: first hit is underlying patient factors causing adherence of neutrophils to the pulmonary endothelium; second hit is caused by mediators in the blood transfusion that activate the neutrophils and endothelial cells.
Differential
Can be confused or overlap with TACO or transfusion-associated volume/circulatory overload, which presents similarly but has evidence of increased BNP, CVP, pulmonary wedge pressure, and left sided heart pressures. Patients with TACO tend to improve with diuretic treatment
Supportive tests
Echocardiogram
BNP (tends to be low)
Transient leukopenia
Treatment
Supportive care
Lung protective ventilation strategies
Fluid restrictive strategy
Aspirin (shown to be helpful in animal studies)
Pre-washing of stored RBCs prior to transfusion
Decrease the amount of transfusions!
References
Lancet. 2013 Sep 14;382(9896):984-94. doi: 10.1016/S0140-6736(12)62197-7. Epub 2013 May 1.
Transfusion-related acute lung injury: a clinical review.
