Transfusion related acute lung injury presenting with acute dyspnoea: A case report
Publication Type:Journal Article
Source:Journal of Medical Case Reports, Volume 2 (2008)
Keywords:acute lung injury, adult, article, artificial ventilation, blood transfusion reaction, case report, clinical feature, differential diagnosis, disease course, dobutamine, dopamine, dyspnea, female, fever, general condition deterioration, hemodynamic parameters, human, lung infiltrate, noradrenalin, oxygen saturation, positive end expiratory pressure, postoperative period, priority journal, respiratory distress, tachycardia, tachypnea, thorax pain, thorax radiography, treatment response
Introduction: Transfusion-related acute lung injury is emerging as a common cause of transfusion-related adverse events. However, awareness about this entity in the medical fraternity is low and it, consequently, remains a very under-reported and often an under-diagnosed complication of transfusion therapy. Case presentation: We report a case of a 46-year old woman who developed acute respiratory and hemodynamic instability following a single unit blood transfusion in the postoperative period. Investigation results were non-specific and a diagnosis of transfusion-related acute lung injury was made after excluding other possible causes of acute lung injury. She responded to symptomatic management with ventilatory and vasopressor support and recovered completely over the next 72 hours. Conclusion: The diagnosis of transfusion-related acute lung injury relies on excluding other causes of acute pulmonary edema following transfusion, such as sepsis, volume overload, and cardiogenic pulmonary edema. All plasma containing blood products have been implicated in transfusion-related acute lung injury, with the majority being linked to whole blood, packed red blood cells, platelets, and fresh-frozen plasma. The pathogenesis of transfusion-related acute lung injury may be explained by a "two-hit" hypothesis, involving priming of the inflammatory machinery and then activation of this primed mechanism. Treatment is supportive, with prognosis being substantially better than for most other causes of acute lung injury. © 2008 Haji et al; licensee BioMed Central Ltd.
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