- Looney, Mark R;
- Roubinian, Nareg;
- Gajic, Ognjen;
- Gropper, Michael A;
- Hubmayr, Rolf D;
- Lowell, Clifford A;
- Bacchetti, Peter;
- Wilson, Gregory;
- Koenigsberg, Monique;
- Lee, Deanna C;
- Wu, Ping;
- Grimes, Barbara;
- Norris, Philip J;
- Murphy, Edward L;
- Gandhi, Manish J;
- Winters, Jeffrey L;
- Mair, David C;
- Schuller, Randy M;
- Hirschler, Nora V;
- Rosen, Rosa Sanchez;
- Matthay, Michael A;
- Toy, Pearl
Objective
Transfusion-related acute lung injury is the leading cause of transfusion-related mortality. A prospective study using electronic surveillance was conducted at two academic medical centers in the United States with the objective to define the clinical course and outcomes in transfusion-related acute lung injury cases.Design
Prospective case study with controls.Setting
University of California, San Francisco and Mayo Clinic, Rochester.Patients
We prospectively enrolled 89 patients with transfusion-related acute lung injury, 164 transfused controls, and 145 patients with possible transfusion-related acute lung injury.Interventions
None.Measurements and main results
Patients with transfusion-related acute lung injury had fever, tachycardia, tachypnea, hypotension, and prolonged hypoxemia compared with controls. Of the patients with transfusion-related acute lung injury, 29 of 37 patients (78%) required initiation of mechanical ventilation and 13 of 53 (25%) required initiation of vasopressors. Patients with transfusion-related acute lung injury and possible transfusion-related acute lung injury had an increased duration of mechanical ventilation and increased days in the ICU and hospital compared with controls. There were 15 of 89 patients with transfusion-related acute lung injury (17%) who died, whereas 61 of 145 patients with possible transfusion-related acute lung injury (42%) died and 7 of 164 of controls (4%) died. Patients with transfusion-related acute lung injury had evidence of more systemic inflammation with increases in circulating neutrophils and a decrease in platelets compared with controls. Patients with transfusion-related acute lung injury and possible transfusion-related acute lung injury also had a statistically significant increase in plasma interleukin-8, interleukin-10, and interleukin-1 receptor antagonist posttransfusion compared with controls.Conclusions
In conclusion, transfusion-related acute lung injury produced a condition resembling the systemic inflammatory response syndrome and was associated with substantial in-hospital morbidity and mortality in patients with transfusion-related acute lung injury compared with transfused controls. Patients with possible transfusion-related acute lung injury had even higher in-hospital morbidity and mortality, suggesting that clinical outcomes in this group are mainly influenced by the underlying acute lung injury risk factor(s).