Transfusion and Acute Respiratory Distress Syndrome: Pathogenesis and Potential Mechanisms
The association between blood transfusion and lung injury is a consistent finding in experimental and clinical research. The presence of an inflammatory condition appears to be a prerequisite, which translated to specific patient risk factors, includes tr
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Transfusion and Acute Respiratory Distress Syndrome: Pathogenesis and Potential Mechanisms Nicole P. Juffermans and Alexander P. Vlaar
Introduction The association between blood transfusion and lung injury or its more severe form acute respiratory distress syndrome (ARDS) has been noted already since the early seventies. Since then, it is a consistent finding in multiple clinical trials in different patient populations. In the association between transfusion and lung injury, both patient- and transfusion-related risk factors play a role. Identification of these risk factors has shed some light on the pathogenesis of lung injury following transfusion, although many questions remain. In terms of patient factors, it has become more and more clear that the association between transfusion and ARDS is more prevalent in the critically ill, in trauma and other surgical patients [1], the epidemiology of which is discussed in Chap. 11. In terms of mechanisms, it can be argued that the relation between transfusion and ARDS reflects the fact that transfusion is merely a confounder in the occurrence of lung injury, as patients who have lung injury are more ill, with a concomitant more profound anemia and subsequent more frequent exposure to transfusion. However, recent data strongly suggests that there is a causal relationship between transfusion and lung injury, with clear proof of principal in either experimental settings [2–7] or using experimental methods of measuring lung edema in the clinical setting [8]. Increasingly, patient-related risk factors are recognized as the most relevant risk factors for the development of lung injury following transfusion [9]. In terms of transfusion-related risk factors, plasma containing blood products are the blood products most frequently involved in the occurrence of lung injury, and are also associated with fatal pulmonary reactions. Antibodies in the blood product directed at cognate antigens in the recipient have been implicated, but these N.P. Juffermans, MD, PhD (*) • A.P. Vlaar, MD, PhD Laboratory of Experimental Intensive Care and Anesthesiology, Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands e-mail: [email protected] © Springer International Publishing Switzerland 2017 J.S. Lee, M.P. Donahoe (eds.), Hematologic Abnormalities and Acute Lung Syndromes, Respiratory Medicine, DOI 10.1007/978-3-319-41912-1_10
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194 Table 10.1 Definition of transfusion-related acute lung injury
N.P. Juffermans and A.P. Vlaar TRALI – Acute onset within 6 h after a blood transfusion – PaO2/FiO2
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