Original article

Blood Transfusion - 3 2018 (May - June)

Reporting transfusion-related acute lung injury by clinical and preclinical disciplines

Authors

Key words: haemovigilance, reporting, transfusion-related acute lung injury, two-hit model, vignette study
Publication Date: 2017-04-05

Abstract

Background. Disciplines involved in diagnosing transfusion-related acute lung injury (TRALI) report according to a "one-hit" theory. However, studies showed that patients with an underlying condition are at increased risk of the development of TRALI. We investigated whether accumulating evidence on the "two-hit" theory has changed the practice of reporting TRALI.
Materials and methods. Departments of haematology, haemovigilance, transfusion medicine, intensive care and anaesthesiology from all Dutch hospitals with at least five beds equipped for mechanical ventilation were invited to participate in an online survey. Using clinical vignettes with conjoint analysis we investigated the effect of patients' age, admission diagnosis, type and number of transfusions and presence of risk factors for acute lung injury on TRALI reporting. A positive b-coefficient indicated a higher likelihood of reporting TRALI.
Results. We received 129 questionnaires (response rate 74%). Respondents were more likely to report TRALI in younger patients, if symptoms developed within 2 hours of transfusion and if patients had received multiple transfusions. Sepsis and the presence of a risk factor for acute lung injury reduced the inclination to report. Transfusion medicine physicians and haemovigilance staff no longer took the age of transfusion products into account in their diagnostic considerations on TRALI.
Discussion. We conclude that the multidisciplinary team involved in TRALI reporting, still considers TRALI a "one-hit" event, despite accumulating evidence that supports the "two-hit" theory. These results suggest that the patients most at risk of developing TRALI are not reported to the blood bank.

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Authors

Anna L. Peters - Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam

Emma K. van de Weerdt - Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam

Eline J. Goudswaard - Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam

Jan M. Binnekade - Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam

Jaap J. Zwaginga - Department of Immunohematology and Blood Transfusion, Leiden University Medical Centre, Leiden; Centre for Clinical Transfusion Research, Sanquin Research, Leiden

Erik A.M. Beckers - Department of Internal Medicine-Haematology, Maastricht University Medical Centre, Maastricht

Sacha S. Zeerleder - Department of Haematology, Academic Medical Centre, Amsterdam; Department of Immunopathology, Sanquin Research, Amsterdam

Marian G.J. van Kraaij - Department of Transfusion Medicine, Sanquin Blood Bank, Amsterdam

Nicole P. Juffermans - Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam; Laboratory of Experimental Intensive Care Medicine, Academic Medical Centre, Amsterdam, the Netherlands

Alexander P.J. Vlaar - Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam; Laboratory of Experimental Intensive Care Medicine, Academic Medical Centre, Amsterdam, the Netherlands

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