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[Transfusion-associated acute pulmonary insufficiency: a rare, but life-threatening transfusion reaction].

Two patients developed within several hours after blood transfusion severe shortness of breath which required temporary artificial ventilation. X-ray pictures of the chest showed pulmonary edema in both patients. No cardiac causes for edema were found. Detection of granulocyte antibodies in the sera of one patient and one blood donor confirmed the suspected diagnosis of transfusion-related acute lung injury.

Acute Disease↗

Blood transfusion reactions involving an immune response.

The majority of reactions that occur during blood transfusion are stimulated when the recipient receives antigen from donor blood to which he has developed antibody. The reaction may be immediate or insidious in its onset. Side effects range from mild discomfort to death. The transfusionist needs to be able to distinguish symptoms of a reaction and be prepared to treat them immediately.

Blood Group Incompatibility↗

Chronic granulomatous disease and the Mcleod phenotype. Successful treatment of infection with granulocyte transfusions resulting in subsequent hemolytic transfusion reaction.

A young man with X-linked chronic granulomatous disease of childhood, who is of the rare McLeod phenotype with antibodies in his serum shown to be hemolytic and reactive against all red cells with normal expressions of the Kell antigens, developed a severe Nocardia pneumonia with abscess formation and was subsequently treated successfully with granulocyte transfusions in spite of the presence of anti-KX in the patient's serum. The anti-KX did not appear to alter significantly the effectiveness of the transfused granulocytes; it did, however, cause a mild hemolytic transfusion reaction. The patient made a remarkable recovery from this episode and his condition has progressed to a state satisfactory enough for him to donate his own blood for storage and possible use in the future.

Adult↗

Delayed hemolytic transfusion reaction and paroxysmal cold hemoglobinuria: an unusual association.

An 80-year-old female presented with melena and anemia due to bleeding from a benign gastric ulcer. Her blood group was O, D+. The serum contained anti-B and a weak anti-A (titer 2 at 18 degrees C). She was inadvertently transfused with approximately 3.5 units of group A red blood cells with no initial ill effects. One week later, the anti- A titer increased to 8 and the direct antiglobulin test (DAT) was weakly positive (IgG and C3d). The next day, intravascular hemolysis became evident. The DAT was still weakly positive and the serum contained a weak cold autoagglutinin, which did not correlate with the severity of the hemolysis. A Donath-Landsteiner test was performed and found to be strongly positive. The antibody showed P specificity, confirming a diagnosis of paroxysmal cold hemoglobinuria (PCH). Exchange transfusion was followed by rapid recovery even though the Donath-Landsteiner test remained positive for at least a month. The patient was well when last seen 11 months after presentation. It was thought that the original low titer of anti-A reflected compromised immune homeostasis in an elderly patient and that stimulation by incompatible blood in those circumstances resulted in a delayed hemolytic transfusion reaction that triggered, exacerbated, or was accompanied by an autoimmune response manifesting as PCH.

Journal Article↗

Transfusion-related acute lung injury: a life-threatening transfusion reaction.

BACKGROUND: We present the case of a 57-year-old woman who developed transfusion-related acute lung injury (TRALI) following a transfusion of packed red blood cells (pRBCs). CASE REPORT: A 56-year-old woman had undergone a low anterior resection in 2002 because of a Duke's stage D adenocarcinoma of the rectum. In June 2003 she was referred to our department, presenting symptoms and signs of ileus. Abdominal radiograph revealed multiple air-fluid levels, while a computed tomography scan showed disease dissemination. Colonoscopic control verified recurrent disease in the anastomotic area. At surgery, a palliative loop ostomy was generated. In the 4(th) postoperative day it was decided that one unit of pRBCs be transfused. pRBC administration complicated with a severe reaction, developing within 35 minutes of the transfusion episode. The diagnosis of TRALI syndrome was based on clinical signs and symptoms. Hemodynamic stabilization and resuscitation required low doses of epinephrine, diuretics, and a high concentration of inspired oxygen in combination with bronchodilators. Ventilatory assistance was not required. Clinical improvement occurred 12 hours later. Full recovery of the syndrome was observed in 6 days, while chest X-ray returned to normal findings within 4 days. CONCLUSIONS: TRALI syndrome is an immune-mediated transfusion reaction which can cause severe complications or even death. Early diagnosis and treatment improves survival and usually results in full recovery. TRALI remains a clinical diagnosis in an appropriate setting, supported by serologic studies if these are available.

Acute Disease↗

Cytokines in stored red blood cell concentrates: promoters of systemic inflammation and simulators of acute transfusion reactions?

BACKGROUND: The cytokine network has important implications for the systemic inflammatory and metabolic response in trauma and infection. Cytokines exogenously administered to traumatized and infected patients may have implications for the trauma response in these patients. The main objective of this study was to characterize red blood cell concentrates (RBCs) with regard to cytokine content. METHODS: We investigated the concentrations of tumor necrosis factor alpha (TNF), interleukin-1 beta (IL-1), interleukin-6 (IL-6) and interleukin-8 (IL-8) in sixteen units of RBCs stored at +4 degrees C during 40 days. Samples from RBCs were taken every tenth day. Healthy volunteers were used as controls. RESULTS: IL-1 and IL-8 in RBCs were increased compared to controls, P < 0.01 - P < 0.001 and TNF in RBCs were increased on days 1 and 40 compared to controls, P < 0.05. During storage TNF was highest on day 1, 69 (< 3-1060) pg/ml, median (range). IL-1 concentrations increased during the period of storage from 5 (< 2 - 205) pg/ml to 174 (< 2 - 2180) pg/ml, P < 0.01. IL-6 was 6 (< 2 - 210) pg/ml on day 1 and did not change over the period of storage. IL-8 was highest on day 40, 164 (15 - 790) pg/ml and compared to day 1 the concentrations were increased on day 10 and day 40, P < 0.05 for both comparisons. CONCLUSIONS: The results indicate the presence of TNF, IL-1, IL-6 and IL-8 in stored RBCs, though there was a great variability over the period of storage and between units of RBCs. In some samples of RBCs the content of cytokines reached levels that may be anticipated to contribute to systemic inflammation and the symptomatology of acute transfusion reactions.

Adult↗