Tổn thương phổi cấp tính liên quan đến truyền máu (TRALI): Các cân nhắc lâm sàng và sinh lý bệnh hiện tại

Kelly Swanson1, Denis M. Dwyre2, Jessica Krochmal2, Thomas J. Raife2
1Department of Internal Medicine, University of Iowa, Iowa city, US
2Department of Pathology, University of Iowa College of Medicine, Iowa City, USA

Tóm tắt

Tổn thương phổi cấp tính liên quan đến truyền máu (TRALI) là một phản ứng truyền máu hiếm gặp, thể hiện dưới dạng khó thở trong hoặc sau khi truyền các sản phẩm máu. TRALI có mức độ nghiêm trọng khác nhau, và tỷ lệ tử vong không phải là hiếm. Các phản ứng TRALI có sự phân bố giới tính đồng đều và có thể xảy ra ở tất cả các nhóm tuổi. Tất cả các sản phẩm máu, ngoại trừ albumin, đều liên quan đến các phản ứng TRALI. TRALI xuất hiện dưới dạng tổn thương hô hấp cấp tính xảy ra gần thời điểm truyền sản phẩm máu. Cần loại trừ các nguyên nhân khác của tổn thương phổi cấp tính để xác định chính xác chẩn đoán TRALI. Về mặt lâm sàng và bệnh lý, TRALI giống như hội chứng suy hô hấp cấp tính (ARDS), với các chemokine và cytokine viêm xuất phát từ bạch cầu trung tính được cho là có liên quan đến bệnh sinh của cả hai tình trạng này. Kháng thể chống HLA và kháng thể chống bạch cầu trung tính đã được ghi nhận trong một số trường hợp TRALI. Điều trị cho TRALI là hỗ trợ; phòng ngừa là rất quan trọng. Nguy cơ bị nghi ngờ rằng TRALI đang bị chẩn đoán thấp và báo cáo thấp. Một trong những khó khăn trong việc đánh giá các phản ứng TRALI tiềm năng là, cho đến gần đây, thiếu tiêu chí chẩn đoán. Một nhóm chuyên gia về y học truyền máu, Hội nghị đồng thuận Mỹ - Châu Âu (AECC), đã gặp nhau gần đây và phát triển các tiêu chí chẩn đoán TRALI, cũng như các khuyến cáo về quản lý tình nguyện viên để ngăn ngừa các phản ứng TRALI trong tương lai. Dựa trên các khuyến nghị đồng thuận của AECC, chúng tôi báo cáo một trường hợp TRALI ở một bệnh nhân ung thư như một ví dụ về mức độ nghiêm trọng tiềm tàng của bệnh phổi và việc đánh giá lâm sàng và xét nghiệm của bệnh nhân. Chúng tôi cũng xem xét tài liệu về biến chứng quan trọng này của việc truyền máu mà các bác sĩ nội khoa có thể gặp phải.

Từ khóa

#TRALI #tổn thương phổi cấp tính #truyền máu #triệu chứng lâm sàng #sinh lý bệnh #kháng thể chống HLA #kháng thể chống bạch cầu trung tính #ARDS

Tài liệu tham khảo

Ashbaugh D, Bigelow D, Petty T, Levine B (1967) Acute respiratory distress in adults. Lancet 7511:319–323 Barnard R (1951) Indiscriminate transfusion: a critique of case reports illustrating hypersensitivity reactions. N Y State J Med 51:2399–2402 Boxer L, Axtell R, Suchard S (1990) The role of the neutrophil in inflammatory diseases of the lung. Blood Cells 16:25–42 Bux J, Becker F, Seeger W, et al. (1996) Transfusion-related acute lung injury due to HLA-A2 specific antibodies in recipient and NB1-specific antibodies in donor blood. Br J Haematol 93:707–713 Dooren M, Ouwehand W, Verhoeven A, von dem Borne A, Kuijpers R (1998) Adult respiratory distress syndrome after experimental intravenous γ-globulin concentrate and monocyte-reactive IgG antibodies. Lancet 352:1601–1602 Dyers A, Smallwood D, Kotsimbos T, Street A (2000) Transfusion related acute lung injury (TRALI) in a patient with a single lung transplant. Br J Haematol 109:674–676 Engelfriet CP, Reesink HW, Pietersz RN et al. (2001) Universal leukocyte depletion of blood components: cell concentrates and plasma. Vox Sang 81:56–77 Flesch B, Neppert J (2002) Transfusion-related acute lung injury caused by human leukocyte antigen class II antibody. Br J Haematol 116:673–676 Fransen E, Maessen J, Dentener M, Senden N, Buurman W (1999) Impact of blood transfusions on inflammatory mediator release in patients undergoing cardiac surgery. Chest 116(5): 1233–1239 Gloster E, Ranu S, Wang Y, Dimaio T, Laungani S (2004) Transfusion-related acute lung injury (TRALI)-type reaction in a neonate (abstract). Transfusion 44S:108A Hammerschmidt D, Jacob H (1982) Adverse pulmonary reactions to transfusion. Adv Intern Med 27:511–529 Hashim SWR, Kay HR, Hammond GL, Kopf GS, Geha AS (1984) Noncardiogenic pulmonary edema after cardiopulmonary bypass. Am J Surg 147:560–564 Hebert P, Wells G, Blajchman M, et al. (1999) A multicenter randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 340(6):409–417 Heddle N, Klama L, Griffith L, et al. (1993) A prospective study to identify the risk factors associated with acute reactions to platelet and red cell transfusions. Transfusion 33:794–797 Hicks W, Susskind B, Strait R, Finkelman F (2004) In vivo murine model of transfusion-related acute lung injury [abstract]. Transfusion 44S:23A Hogg J, Doerschuk C (1995) Leukocyte traffic in the lung. Annu Rev Physiol 57:97–114 Holness L, Knippen MA, Simmons L, Lachenbruch PA (2004) Fatalities caused by TRALI. Transfus Med Rev 18(3):184–188 Kao G, Wood I, Dorfman D, Milford E, Benjamin R (2003) Investigation into the role of anti-HLA class II antibodies in TRALI. Transfusion 43: 185–191 Kleinman S, Caulfield T, Chan P, et al. (2004) Toward an understanding of transfusion-related acute lung injury: statement of a consensus panel. Transfusion 44:1774–1789 Kopko P, Holland P (1999) Transfusion-related acute lung injury. Br J Haematol 105(2):322–329 Kopko P, Marshall C, MacKenzie M, Holland P, Popovsky M (2002) Transfusion-related acute lung injury report of a clinical look back investigation. JAMA 287(15):1968–1971 Kopko P, Paglieroni T, Popovsky MA, et al. (2003) TRALI: correlation of antigen-antibody and monocyte activation in donor-recipient pairs. Transfusion 43:177–184 Leach M, Vora A, Jones D, Lucas G (1998) Transfusion-related acute lung injury (TRALI) following autologous stem cell transplant for relapsed acute myeloid leukemia: a case report and review of the literature. Transfus Med 8:333–337 Lecamwassam H, Katz D, Vlahakes G, Dzik W, Streckenbach S (2002) Cardiopulmonary bypass following severe transfusion-related acute lung injury. Anesthesiology 97(5):1311–1312 Leger R, Palm S, Wulf H, Vosberg A, Neppert J (1999) Transfusion-related lung injury with leukopenic reaction caused by fresh frozen plasma containing anti-NB1. Anesthesiology 91 (5):1529–1532 Lenahan S, Domen R, Silliman C, Kingsley C, Romano P (2001) Transfusion-related acute lung injury secondary to biologically active mediators. Arch Pathol Lab Med 125:523–526 Leslie K, Wick M (2005) Practical Pulmonary Pathology: A Diagnostic Approach. Churchill Livingstone, Philadelphia, pp 72–77 Levy G, Shabot M, Hart M, Mia W, Goldfinger D (1986) Transfusion-associated noncardiogenic pulmonary edema. Transfusion 26:278–281 Lindgren L, Yli-Hankala A, Halme L, Koskimies S, Orko R (1996) Transfusion-related acute lung injury (TRALI) after fresh frozen plasma in a patient with coagulopathy. Acta Anaesthesiol Scand 40(5):641–644 Lucas G, Rogers S, Evans R, Hambley H, Win N (2000) Transfusion-related acute lung injury associated with interdonor incompatibility for the neutrophil-specific antigen HNA-1a. Vox Sang 79(2):112–115 Matute–Bello G, Liles W, Radella F, et al. (2000) Modulation of neutrophil apoptosis by granulocyte colony-stimulating factor and granulocyte/macrophage colony-stimulating factor during the course of acute respiratory distress syndrome. Crit Care Med 28:1–7 Nakagawa M, Toy P (2004) Acute and transient decrease in neutrophil count in transfusion-related acute lung injury: cases at one hospital. Transfusion 44:1689–1694 Nishimura M, Mitsunaga S, Ishikawa Y, Satake M (2003) Possible mechanisms underlying development of transfusion-related acute lung injury: roles of anti-major histocompatibility complex class II DR antibody. Transfus Med 13:141–147 Nouraei S, Wallis J, Bolton D, Hasan A (2003) Management of transfusion-related acute lung injury with extracorporeal cardiopulmonary support in a four-year-old child. Br J Anaesth 91(2):292–294 Palfi M, Berg S, Ernerudh J, Berlin G (2001) A randomized controlled trial of tranfusion-related acute lung injury: is plasma from multiparous blood donors dangerous? Transfusion 41 (3):317–322 Payne R (1962) The development and persistance of leukoagglutinins in parous women. Blood 19(4):411 Popovsky M (1996) Transfusion-related acute lung injury. In: Transfusion Reactions. M. Popovsky (ed), pp. 167–178, AABB Press, Bethesda Popovsky M (2000) Transfusion-related acute lung injury. Curr Opin Hematol 7:402–407 Popovsky M, Moore S (1985) Diagnostic and pathogenic considerations in transfusion-related acute lung injury. Transfusion 25(6):573–577 Popovsky M, Abel M, Moore S (1983) Transfusion-related acute lung injury associated with passive transfer of antileukocyte antibodies. Am Rev Respir Dis 128:185–189 Popovsky M, Chaplin H, Moore S (1992) Transfusion-related acute lung injury: a neglected serious complication of hemotherapy. Transfusion 32(6):589–592 Porretti L, Coluccio E, Prati D, et al. (2004) Flow-cytometric approach to the prompt laboratory diagonisis of TRALI: a case report. Eur J Haematol 73:295–299 Ramanathan R, Triulzi D, Logan T (1997) Transfusion-related acute lung injury following random donor platelet transfusion: a report of two cases. Vox Sang 73:43–45 Reese E, McCullough J, Craddock P (1975) An adverse pulmonary reaction to cryoprecipitate in a hemophiliac. Transfusion 15(6):583–588 Rizk A, Gorson K, Kenney L, Weinstein R (2001) Transfusion-related acute lung injury after the infusion of IVIG. Transfusion 41(2):264–268 Robbins R, Russ W, Rasmussen J, Clayton M (1987) Activation of the complement system in the adult respiratory distress syndrome. Am Rev Respir Dis 135:651–658 Savill J (1997) Apoptosis in resolution of infammation. J Leukoc Biol 61:375–380 Schmeck J, Janzen R, Münter K, et al. (1998) Endothelin-1 and thromboxane A2 increase pulmonary vascular resistance in granulocyte-mediated lung injury. Crit Care Med 26(11):1868–1874 Seeger W, Schneidner U, Kreusler B, et al. (1990) Reproduction of transfusion-related acute lung injury in an ex vivo lung model. Blood 76(7):1438–1444 Shanwell A, Kristiansson M, Remberger M, Ringden O (1997) Generation of cytokines in red cell concentrates during storage is prevented by prestorage white cell reduction. Transfusion 37:678–684 Silliman C (1999) Transfusion-related acute lung injury. Transfus Med Rev 13(3):177–186 Silliman CC, Thurman G, Ambruso D (1992) Stored blood components contain agents that prime the neutrophil NADPH oxidase through the platelet-activating-factor receptor. Vox Sang 63:133–136 Silliman CC, Dickey W, Paterson A, et al. (1996) Analysis of the priming activity of lipids generated during routine storage of platelet concentrates. Transfusion 36:133–139 Silliman CC, Paterson A, Dickey W, et al. (1997) The association of biologically active lipids with the development of transfusion-related acute lung injury: a retrospective study. Transfusion 37:719–726 Silliman CC, Voelkel N, Allard J, et al. (1998) Plasma and lipids from stored packed red blood cells cause acute lung injury in an animal model. J Clin Invest 101:1458–1467 Silliman C, Bjornsen A, Wyman T, et al. (2003) Plasma and lipids from stored platelets cause acute lung injury in an animal model. Transfusion 43:633–640 Silliman C, Boshkov L, Mehdizadehkashi Z, et al. (2003) Transfusion-related acute lung injury: epidemiology and a prospective analysis of etiologic factors. Blood 101(2):454–462 Stroncek DF, Leonard K, Eiber G, et al. (1996) Alloimmunization after granulocyte transfusions. Transfusion 36(11/12): 1009–1015 Toy P, Hollis–Perry KM, Jun J, Nakagawa M (2004) Recipients of blood from a donor with multiple HLA antibodies: look-back study of transfusion-related acute lung injury. Transfusion 44:1683–1688 Uhlmann E, Isgriggs E, Wallhermfechtel M, Goodnough LT (2001) Prestorage universal WBC reduction of RBC units does not affect the incidence of transfusion reactions. Transfusion 41:997–1000 Urahama N, Tanosaki R, Masahiro K, et al. (2003) TRALI after the infusion of marrow cells in a patient with acute lymphoblastic leukemia. Transfusion 43:1553–1557 Vamvakas E, Carven J (2002) Allogeneic blood transfusion and postoperative duration of mechanical ventilation: effects of red cell supernatant, platelet supernatant, plasma components and total transfused fluid. Vox Sang 82:141–149 Vercellotti G, Yin H, Gustafson K, Nelson R, Jacob H (1998) Platelet-activating factor primes neutrophil responses to agonists: role in promoting neutrophil-mediated endothelial damage. Blood 71(4):1100–1107 Wallis J, Lubenko A, Wells A, Chapman C (2003) Single hospital experience of TRALI. Transfusion 43:1053–1059 Ward H, Lipscomb T, Cawley L (1968) Pulmonary hypersensitivity reaction after blood transfusion. Arch Intern Med 122:362–366 Williamson IM, Lowe S, Love E, et al. (1999) Serious hazards of transfusion (SHOT) initiative: analysis of the first two annual reports. Br Med J 319:16–19 Win N, Montgomery J, Sage D, et al. (2001) Recurrent transfusion-related acute lung injury. Transfusion 41:1421–1425 Win N, Ranasinghe E, Lucas G (2002) Transfusion-related acute lung injury: a 5-year look-back study. Transfusion 12: 387–389 Wu TJ, Teng RJ, Tsou Yau KI (1996) Transfusion-related acute lung injury treated with surfactant in a neonate. Eur J Pediatr 155:589–591 Zoon KG (2002) Transfusion related acute lung injury. In: Research CfBEa, Administration FaD, eds. Department of Health and Human Services, Washington, DC Zupanska B, Uhrynowska M, Konopka L (1999) Transfusion-related acute lung injury due to granulocyte-agglutinating antibody in a patient with paroxysmal nocturnal hemoglobinuria. Transfusion 39:944–947