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. 2017 Aug;21(8):506-513.
doi: 10.4103/ijccm.IJCCM_380_16.

Association of Massive Transfusion for Resuscitation in Gastrointestinal Bleeding with Transfusion-related Acute Lung Injury

James J Case  1 , Nasreen Khan  2 , Michael Delrahim  1 , Jasmina Dizdarevic  1 , Dane J Nichols  1 , Martin A Schreiber  3 , Thomas G Deloughery  4 , Akram Khan  1
Affiliations

Association of Massive Transfusion for Resuscitation in Gastrointestinal Bleeding with Transfusion-related Acute Lung Injury

James J Case et al. Indian J Crit Care Med. 2017 Aug.

Abstract

Background and aims: This study aimed to understand the use of massive transfusion (MT) for gastrointestinal bleeding (GIB).

Patients and methods: We performed a retrospective analysis of patients admitted to our medical Intensive Care Unit (ICU) with GIB for the type of bleeding, quantity of blood products transfused, and risk of transfusion-related acute lung injury (TRALI) and death. MT was defined as transfusion of 10 or more units of red blood cell (RBC) within a 24-h period in a 1-unit RBC: 1-unit fresh frozen plasma: and 1-unit platelet ratio. TRALI was defined as development of acute lung injury (ALI), within 6 h of transfusion, with new bilateral pulmonary infiltrates, absence of circulatory overload, or other explanation for ALI.

Results: In a 43-month interval, 169 patients were admitted to the ICU with GIB and received blood products, of whom 13 received MT. Ten patients developed TRALI, of whom 7 (70%) had received MT. MT was associated with an increased risk of TRALI (odds ratio [OR]: 17.9, 95% confidence interval [CI]: 2.9-111.2, P = 0.002) after adjusting for age, sex, body mass index, baseline vitals, and laboratory data. Death was predicted by MT (OR: 5.6, 95% CI: 1.6-19.7, P = 0.007), TRALI (OR: 2.3, 95% CI: 1.1-4.6, P = 0.02), and Acute Physiologic Chronic Health Evaluation II score (OR: 1.17 per unit increase, 95% CI: 1.09-1.26, P < 0.001) after adjusting for age and sex.

Conclusions: MT for GIB is associated with an increased risk of TRALI and death. Prospective studies assessing the use of MT in this population are needed to understand and improve outcomes.

Keywords: Blood transfusion; Intensive Care Unit; gastrointestinal bleeding; massive transfusion; outcomes; resuscitation.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Patient selection flow sheet
Figure 2
Figure 2
Units of blood products transfused in 1st 24 h of presentation. RBC: Red blood cell, PLT: Platelet, FFP: Fresh frozen plasma
Figure 3
Figure 3
Units of blood products transfused during the entire hospitalization. RBC: Red blood cell, PLT: Platelet, FFP: Fresh frozen plasma
See this image and copyright information in PMC

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