Transfusion-related acute lung injury: from bedside to bench and back

摘要: Over the past 60 years, transfusion medicine community has attained significant knowledge regarding transfusion-related acute lung injury (TRALI) through bedside to bench and back model. First, at bedside, TRALI causes hypoxia noncardiogenic pulmonary edema, typically within 6 hours of transfusion. Second, studies showed a higher incidence in plasma platelet products than red blood cell (the fatal for is 1:2-300 000 products; platelet, 1:3-400 000; cells, 1:25 002 000), as well an association with donor leukocyte antibodies (∼ 80% cases). Third, bench, antibody-dependent antibody-independent mechanisms have been described, requiring neutrophil endothelial activation. Antibodies, alternate substances products, result activation, which, susceptible patient, (2-hit hypothesis). Fourth, policy changes based on results these studies, such minimizing use from donors antibodies, decreased TRALI. Thus, steps mitigate are place, but complete mechanistic understanding pathogenesis which patients highest risk remains be elucidated.