| Lesión pulmonar aguda producida por transfusión |
J.M. Añón, A.García de Lorenzo, M.Quintana, E.González y M.J. Bruscas
Med Intensiva.2010;34(2):139-149
Resumen
El término TRALI (transfusion related acute lung injury ¨ lesión pulmonar aguda producida por transfusión¨) fue acuñado en1985. Es un síndrome clínico relativamente raro, que puede constituir una amenaza para la vida y que se caracteriza por insuficiencia respiratoria aguda y edema pulmonar no cardiogénico durante o después de una transfusión de productos hemáticos. Aunque su verdadera incidencia es desconocida se le ha atribuido un caso por cada 5.000 transfusiones de cualquier producto hemático y ha sido la causa más frecuente de muerte relacionada con la transfusión durante 3 años en Estados Unidos. Se han propuesto2etiologıas. La primera es un episodio mediado por anticuerpos debido a la transfusión de anticuerpos contra el antígeno leucocitario o anticuerpos antigranulocito a pacientes cuyos leucocitos presentan antígenos afines. La segunda es un modelo en el que se precisan 2 eventos: el primero está relacionado con el cuadro clínico del receptor (sepsis, trauma, etc.) que produce activación endotelial y secuestro de neutrófilos, y el segundo es la transfusión de sustancias con capacidad de modificar la respuesta biológica que activa los leucocitos adheridos que produce daño endotelial y aumento de permeabilidad capilar. El tratamiento es de soporte en función de la gravedad del cuadro clínico, y la prevención se centra en 3 estrategias: selección de donantes, actuación sobre el almacenamiento de los productos hemáticos y evitar las transfusiones innecesarias.Archivo en PDF
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| Lesión pulmonar aguda relacionada a la transfusión: un cambio de perspectiva |
Transfusion-related acute lung injury: a change of perspective.
Vlaar AP, Schultz MJ, Juffermans NP.
Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Centre, Amsterdam, the Netherlands. a.p.vlaar@amc.uva.nl
Neth J Med. 2009 Nov;67(10):320-6.
Abstract
Two decades ago, transfusion-related acute lung injury (TRALI) was considered a rare complication of transfusion medicine. Nowadays, TRALI has emerged as the leading cause of transfusion-related mortality, presumably as a consequence of reaching international agreement on defining TRALI with subsequent increased recognition and reporting of TRALI cases. Specific patient populations such as critically ill patients have an increased risk of developing TRALI, which may be explained by the two-event hypothesis. The first event is the underlying condition of the patient resulting in priming of neutrophils. The second event is the transfusion of a blood product, after which either antibodies or bioactive lipids activate the primed neutrophils, resulting in pulmonary oedema. As opposed to the traditional view that TRALI has a good prognosis, TRALI may have a significant impact on morbidity and outcome, at least in specific patient groups. The association of transfusion with adverse outcome calls for blood product and donor management strategies aimed at decreasing the risk of acquiring TRALI. Excluding female donors from plasma donation seems to have reduced, but not prevented the occurrence of TRALI . Additional research is needed to determine whether the use of fresh blood products may be an additional measure to reduce TRALI. Studies are also needed to identify at-risk patients. In these studies, we advocate the use of the consensus definition to improve comparability of risk factors and outcome of TRALI across patient populations.
http://www.njmonline.nl/getpdf.php?id=10000516
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| Identificación de anticuerpos específicos contra los antígenos de leucocitos humanos en donadores de sangre |
Identification of specificities of antibodies against human leukocyte antigens in blood donors.
Endres RO, Kleinman SH, Carrick DM, Steele WR, Wright DJ, Norris PJ, Triulzi D, Kakaiya R, Busch MP; National Heart, Lung, and Blood Institute Retrovirus Epidemiology Donor Study-II.
Blood Systems Research Institute, San Francisco, California 85282, USA.rendres@bloodsystems.org
Transfusion. 2010 Aug;50(8):1749-60. doi: 10.1111/j.1537-2995.2010.02589.x. Epub 2010 Feb 11.
Abstract
BACKGROUND: Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality. Blood centers are implementing TRALI risk reduction strategies based on screening apheresis donors for antibodies to human leukocyte antigens (HLA). STUDY DESIGN AND METHODS: HLA antibody screening was performed on 7920 blood donors from the Leukocyte Antibody Prevalence Study (LAPS) using Luminex-based normalized background (NBG) cutoff ratios of 10.8 (Class I) and 6.9 (Class II). Single antigen bead (SAB) assay cutoffs of 2500 median fluorescence intensity units (Class I) and 1500 (Class II) were established based on results of two subpopulations of LAPS donors. Antibody frequencies against HLA A, B, C, DR, DQ, and DP antigens were determined for screen-reactive donors with prior pregnancies. RESULTS: SAB reactivity for samples above our multiantigen bead NBG cutoffs was 78% for Class I and 79% for Class II. The SAB-positive rate increased among women with zero to four or more pregnancies (0.3%-15.6% Class I and 0.4%-18% Class II; p < 0.00001). The highest frequency antibodies were DR11 and B15 (4.4% of women with prior pregnancies). The majority of Class I positives contained more than five specificities. For Class II, antibody-positive women segregated into two groups: a single specificity or more than five specificities. CONCLUSIONS: Identification of HLA antigen specificities supports pregnancy associations previously found with screening assays. The significance of particular HLA specificities for inducing TRALI is currently being evaluated in a large lookback study of recipients of high-plasma-volume components from this donor cohort.
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