The reported incidence of transfusion related acute lung injury (TRALI) varies due to the lack of standardized definition. Using the Toronto Consensus Panel definition, we aimed to describe the incidence of TRALI, possible TRALI and transfusion associated circulatory overload (TACO) in critically ill patients not requiring respiratory support at the time of transfusion.
Patients were identified using custom electronic surveillance system consisting of institutional transfusion database and respiratory information system which accurately chart time of transfusion and onset of respiratory support. Respiratory failure was defined as the onset of noninvasive or invasive ventilator support within 6 hours of transfusion. Electronic records of patients with respiratory failure were reviewed by experts and cases categorized as TRALI, possible TRALI and TACO, according to definition.
8902 units were transfused in 1351 critically ill patients, not requiring respiratory support at the time of transfusion. 94 patients required new respiratory support within 6 hours of transfusion. Of 49 patients with confirmed acute pulmonary edema, experts identified 7 TRALIs, 17 possible TRALIs and 25 cases with TACO. The incidence of TRALI was 1/356 per unit transfused, possible TRALI was 1/193 per unit transfused and TACO was 1/120 per unit transfused. Acute pulmonary edema developed after 1 in 49 fresh frozen plasma units (FFP), 1 in 59 platelet units and 1 in 72 of red blood cell (RBC) units. Compared to patients who did not develop pulmonary edema the mean number of FFP units was significantly higher in the TRALI group (4.7 vs 1.9, p=0.002). There was no significant difference in mean and maximum storage age of RBC and donor gender between the patients who did and did not develop TRALI, possible TRALI or TACO after transfusion.
In the ICU, pulmonary edema is commonly temporally associated with blood product transfusion. The incidence of TRALI and TACO appears to be higher than previously reported and was highest after transfusion of FFP.
Both TRALI and TACO are important causes of respiratory failure after transfusion.
Rimki Rana, None.