Anesth Pain Med.  2019 Jan;14(1):35-39. 10.17085/apm.2019.14.1.35.

Transfusion-related acute lung injury in a parturient diagnosed with myelodysplastic syndrome: A case report

• Sung TY
• Jee YS
• Lee SJ
• You HJ
• Jeong KS
• Kang PS

• KMID: 2434196
• DOI: http://doi.org/10.17085/apm.2019.14.1.35

Abstract

Transfusion-related acute lung injury (TRALI) is defined as a new episode of acute lung injury that occurs during or within 6 hours of a completed transfusion, which is one of the leading causes of transfusion-related morbidity and mortality. We present a case of TRALI in a 29-year-old parturient with myelodysplastic syndrome scheduled for cesarean section. The parturient developed hypoxemia and dyspnea after preoperative transfusion of platelets following apheresis to eliminate a unit of leucocyte in order to correct thrombocytopenia. She underwent emergent caesarean section for fetal distress. After surgery, the chest radiograph showed diffuse haziness of both lung fields. Direct and indirect antiglobulin tests were negative, and hemolytic transfusion reaction was ruled out. Pro-BNP 347.3 pg/ml also excluded transfusion-associated circulatory overload. The parturient completely recovered after oxygen support for 2 days. It is important to recognize TRALI as soon as possible to minimize perioperative morbidity and mortality.

Keyword

Cesarean section; Dyspnea; Myelodysplastic syndrome; Transfusion-related acute lung injury

MeSH Terms

Acute Lung Injury*
Adult
Anoxia
Blood Component Removal
Cesarean Section
Coombs Test
Dyspnea
Female
Fetal Distress
Humans
Lung
Mortality
Myelodysplastic Syndromes*
Oxygen
Pregnancy
Radiography, Thoracic
Thrombocytopenia
Transfusion Reaction
Oxygen

Figure

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  Fig. 1 Chest X-ray taken after cesarean section showing diffuse haziness of both lung fields and air bronchograms.

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  Fig. 2 Chest X-ray taken after oxygen therapy (on postoperative day 3) showing clearness of both lung fields.

Reference

1. Popovsky MA, Abel MD, Moore SB. Transfusion-related acute lung injury associated with passive transfer of antileukocyte antibodies. Am Rev Respir Dis. 1983; 128:185–9. DOI: 10.1164/arrd.1983.128.1.185. PMID: 6603182.

2. Toy P, Popovsky MA, Abraham E, Ambruso DR, Holness LG, Kopko PM, et al. Transfusion-related acute lung injury: definition and review. Crit Care Med. 2005; 33:721–6. DOI: 10.1097/01.CCM.0000159849.94750.51. PMID: 15818095.

3. Jin SM, Jang MJ, Huh JY, Park MH, Song EY, Oh D. A case of transfusion-related acute lung injury induced by anti-human leukocyte antigen antibodies in acute leukemia. Korean J Hematol. 2012; 47:302–6. DOI: 10.5045/kjh.2012.47.4.302. PMID: 23320011. PMCID: PMC3538804.

4. Lee HJ, Jeong MA, Jeong JS, Han MK, Jun JH. Case reports: a case of acute lung injury after transfusion during cesarean section. Korean J Crit Care Med. 2011; 26:184–7. DOI: 10.4266/kjccm.2011.26.3.184.

5. Kim KW, Park JS, Kim JW, Choe WJ, Kim KT, Kim JY, et al. A suspected case of transfusion-related acute lung injury in a 30-year old parturient with gestational ITP – a case report? Anesth Pain Med. 2011; 6:275–9.

6. Silliman CC, McLaughlin NJ. Transfusion-related acute lung injury. Blood Rev. 2006; 20:139–59. DOI: 10.1016/j.blre.2005.11.001.

7. Kim J, Na S. Transfusion-related acute lung injury;clinical perspectives. Korean J Anesthesiol. 2015; 68:101–5. DOI: 10.4097/kjae.2015.68.2.101. PMID: 25844126. PMCID: PMC4384395.

8. Bux J. Transfusion-related acute lung injury (TRALI): a serious adverse event of blood transfusion. Vox Sang. 2005; 89:1–10. DOI: 10.1111/j.1423-0410.2005.00648.x. PMID: 15938734.

9. Kleinman S, Caulfield T, Chan P, Davenport R, McFarland J, McPhedran S, et al. Toward an understanding of transfusion-related acute lung injury: statement of a consensus panel. Transfusion. 2004; 44:1774–89. DOI: 10.1111/j.0041-1132.2004.04347.x. PMID: 15584994.

10. Kim MO. Transfusion-related acute lung injury. Korean J Crit Care Med. 2012; 27:1–4. DOI: 10.4266/kjccm.2012.27.1.1.

11. Hébert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion requirements in critical care investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999; 340:409–17. DOI: 10.1056/NEJM199902113400601. PMID: 9971864.

12. Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, et al. Incidence and outcomes of acute lung injury. N Engl J Med. 2005; 353:1685–93. DOI: 10.1056/NEJMoa050333.

13. Popovsky MA, Moore SB. Diagnostic and pathogenetic considerations in transfusion-related acute lung injury. Transfusion. 1985; 25:573–7. DOI: 10.1046/j.1537-2995.1985.25686071434.x. PMID: 4071603.

14. Steinberg KP, Hudson LD, Goodman RB, Hough CL, Lanken PN, Hyzy R, et al. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med. 2006; 354:1671–84. DOI: 10.1056/NEJMoa051693. PMID: 16625008.