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. 2010 Oct;36(10):1710-1717.
doi: 10.1007/s00134-010-1954-x. Epub 2010 Jul 24.

Transfusion-related acute lung injury in ICU patients admitted with gastrointestinal bleeding

Alexander B Benson  1 , Gregory L Austin  2 , Mary Berg  3 , Kim K McFann  4 , Sila Thomas  5 , Gina Ramirez  5 , Hugo Rosen  2 , Christopher C Silliman  5 , Marc Moss  6
Affiliations

Transfusion-related acute lung injury in ICU patients admitted with gastrointestinal bleeding

Alexander B Benson et al. Intensive Care Med. 2010 Oct.

Abstract

Purpose: Transfusion of blood components is common in patients admitted to the intensive care unit (ICU) for gastrointestinal (GI) bleeding, yet the incidence and risk factors for development of transfusion-related acute lung injury (TRALI) in these patients are unknown.

Methods: Patients admitted to a medical ICU for GI bleeding (n = 225) were analyzed for patient- and transfusion-specific risk factors for development of TRALI.

Results: In transfused patients (n = 150), the incidence of TRALI was 15% [95% confidence interval (CI), 10-21%] and accounted for 76% (22/29) of all acute lung injury (ALI) cases. Transfused patients with end-stage liver disease (ESLD) (n = 72) developed TRALI more frequently than those without ESLD (29% versus 1%, p < 0.01). Fresh frozen plasma (FFP) was temporally associated with TRALI in 86% of cases. Transfusion-specific risk factors for development of TRALI included number of transfused units of FFP and nonleukoreduced red blood cells. Patient-specific risk factors included Model for End-Stage Liver Disease (MELD) score, admission serum albumin level, and presence of ALI risk factors.

Conclusions: TRALI is common in critically ill ESLD patients with gastrointestinal bleeding. Nonleukoreduced red blood cells and FFP are significant transfusion-specific risk factors and their use should be re-evaluated in bleeding patients with ESLD.

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Flow chart detailing recruitment of subjects subgroup analyses
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