Transfusionsassoziierte akute Lungeninsuffizienz

TY - JOUR

T1 - Transfusionsassoziierte akute Lungeninsuffizienz

AU - Tank, S

AU - Sputtek, A

AU - Kiefmann, R

PY - 2013/4/1

Y1 - 2013/4/1

N2 - Transfusion-related acute lung injury (TRALI) developed into the leading cause of transfusion-related morbidity and mortality after the first description by Popovsky et al. approximately three decades ago. It was the most frequent reason for transfusion-related fatalities worldwide before implementation of risk minimization strategies by donor selection. Plasma-rich blood products, such as fresh frozen plasma and apheresis platelets seem to be the leading triggers of TRALI. Hypoxemia and development of pulmonary edema within 6 h of transfusion are the diagnostic criteria for TRALI. The differentiation between cardiac failure and other transfusion-related lung injuries, such astransfusion-associated circulatory overload ( TACO) is difficult and causal treatment is not available. Therapy is based on supportive measures, such as oxygen insufflationor mechanical ventilation. The exactly pathogenesis is still unknown but the most propagated hypothesis is the two-event-model. Neutrophils are primed by the underlying condition, e.g. sepsis or trauma during the first event and these primed neutrophils are activated by transfused leukoagglutinating antibodies (immunogen) or bioreactive mediators (non-immunogen) during the second-event. Transfusion of leukoagglutinating antibodies from female donors with one or more previous pregnancies is the most frequent reason. No more TRALI fatalities were reported after implementation of the donor selection in Germany in 2009.

AB - Transfusion-related acute lung injury (TRALI) developed into the leading cause of transfusion-related morbidity and mortality after the first description by Popovsky et al. approximately three decades ago. It was the most frequent reason for transfusion-related fatalities worldwide before implementation of risk minimization strategies by donor selection. Plasma-rich blood products, such as fresh frozen plasma and apheresis platelets seem to be the leading triggers of TRALI. Hypoxemia and development of pulmonary edema within 6 h of transfusion are the diagnostic criteria for TRALI. The differentiation between cardiac failure and other transfusion-related lung injuries, such astransfusion-associated circulatory overload ( TACO) is difficult and causal treatment is not available. Therapy is based on supportive measures, such as oxygen insufflationor mechanical ventilation. The exactly pathogenesis is still unknown but the most propagated hypothesis is the two-event-model. Neutrophils are primed by the underlying condition, e.g. sepsis or trauma during the first event and these primed neutrophils are activated by transfused leukoagglutinating antibodies (immunogen) or bioreactive mediators (non-immunogen) during the second-event. Transfusion of leukoagglutinating antibodies from female donors with one or more previous pregnancies is the most frequent reason. No more TRALI fatalities were reported after implementation of the donor selection in Germany in 2009.

KW - Acute Lung Injury

KW - Adult

KW - Blood Donors

KW - Blood Safety

KW - Blood Transfusion

KW - Diagnosis, Differential

KW - Female

KW - Germany

KW - Heart Failure

KW - Humans

KW - Incidence

KW - Oxygen Inhalation Therapy

KW - Plasma

KW - Platelet Transfusion

KW - Pregnancy

KW - Prognosis

KW - Respiration, Artificial

KW - Risk Factors

KW - Risk Reduction Behavior

U2 - 10.1007/s00101-013-2163-0

DO - 10.1007/s00101-013-2163-0

M3 - SCORING: Zeitschriftenaufsatz

C2 - 23558721

VL - 62

SP - 254

EP - 260

JO - ANAESTHESIST

JF - ANAESTHESIST

SN - 0003-2417

IS - 4

ER -