engleski

A tool to improve clinical recognition and assessment of TRALI

Transfusion related acute lung injury (TRALI) is one of the most common causes of transfusion major morbidity and death. TRALI is still under-diagnosed and under-reported due to inadequate awareness among clinicians. According to expanded definition, TRALI can occur up to 72 hours of transfusion and in patients that have other risk factors for acute lung injury (ALI), i.e. sepsis, aspiration, near drowning, trauma, pneumonia, etc. In Croatia, the incidence of TRALI in Croatia is still unknown and has been only occasionally reported to date. To report on our initial experience with using a tool to improve clinical recognition and assessment of TRALI. A tool was developed as a web based application with the goal to collect evidence based knowledge about TRALI. Data from the cardiac surgery operating room and intensive care unit at Zagreb University Hospital Center were collected and analyzed during a six-month period (Jan-Jun 2009). In this prospective pilot cohort study, all transfused patients were closely observed for the development of ALI, including cardiopulmonary function, chest radiographs, arterial blood gases and central venous saturation within 72 hours of each transfusion, allowing for identification of patients with any grade of respiratory status worsening. Clinical suspicion of the probability of TRALI was made together by two anesthesiologists and one clinical transfusiologist. The informed consent form was signed by all patients and the study was approved by the hospital Ethics Committee. During the study period, 137 of 218 (63%) patients received transfusion of at least one type of blood component during their hospital stay and 17 (12%) developed ALI. Compared to transfused controls, ALI patients were more likely to have sepsis (37% vs. 22%) and massive transfusion (40% vs. 12%). Two of these 17 patients were verified as TRALI cases. Leukocyte antibodies were detected in two of these 17 patients (antibody-mediated TRALI). To our knowledge, this study was the first step in systematic assessment and recognition of TRALI among clinicians in Croatia. The ongoing multicenter, prospective study will allow us to collect more data in the near future and thus improve our clinical and transfusion practice.

TRALI; clinical recognition; transfusion

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