![]() ![]() They may check (I) for “other findings associated with TRALI” (II) if the patients were stable before transfusion (III) whether ALI “clearly developed with the transfusion”, and (IV) weigh the likelihood of other risk factors for ALI in this patients against that of an TRALI. The clinical course of patients “with ALI risk factors other than transfusion” should be evaluated for by critical care specialists for a likelihood of TRALI. The authors concluded basically on the same criteria, but try to go on further after deciding for “possible TRALI”. ARDS, acute respiratory distress syndrome PaO 2, partial pressure arterial oxygen FiO 2, fraction of inspired oxygen TRALI, transfusion-related acute lung injury.Īt the same time, published only 3 months later in 2005, another group convened by the US Heart, Lung, and Blood Institute set out to define TRALI. Recommended criteria for the diagnosis of a TRALI by the Canadian Consensus Conference as decision tree. If any of these conditions coincide with the transfusion of allogenic blood products, the diagnosis “possible TRALI” may be given. Other risk factors for ARDS are aspiration, pneumonia, toxic inhalation, lung contusion, near drowning, severe sepsis, shock, multiple trauma, burn injury, acute pancreatitis, cardiopulmonary bypass or drug overdose. As to not exclude very mild forms of TRALI, the consensus conference on TRALI allows diagnosis of hypoxemia not only by PaO 2/FiO 2, but also by oxygen saturations of below 90% when the patient breathes room air. The ARDS definition criterion to exclude cardiac or circulatory overload reasons for edema rules out a major differential diagnose associated with transfusion, especially in mass transfusion situations. ARDS defined by the AECC shows the characteristic acute decline in arterial oxygenation to ratios of partial pressure arterial oxygen and FiO 2 (PaO 2/FiO 2) of below 300 mmHg plus bilateral infiltrates on frontal chest radiograph. The consensus panel recommends to define TRALI as an acute lung injury (ALI) as defined by the American European Consensus Conference (AECC) on ARDS from 1994 ( 6), that develops within 6 hours of the transfusion of a blood product, and shall not be related to any other cause of ARDS. However, it was the first attempt to sort the evidence there was about lung injury associated with transfusions ( Figure 1). In 2004, the Canadian Blood Service (CBS) and Héma-Québec supported a consensus conference on the central questions about TRALI-the most pressing being: how to define TRALI ( 5)? As there was no evidence through systematic reviews or randomized trials available in the field, the consensus does not contain graded recommendations. Discrimination of possible causes is usually very difficult. Most patient receiving blood products are critically ill and display more than one reason for an acute respiratory distress syndrome (ARDS). Defining TRALI is very difficult as the two cases above suggest. ![]()
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