Unklare akute respiratorische Insuffizienz bei einer 64-jährigen Patientin nach Koronarintervention
| Autor: | Georg Nickenig, Ulrich M. Becher, J O Schwab, Vedat Tiyerili, K Strach, C F Mueller |
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| Rok vydání: | 2010 |
| Předmět: | |
| Zdroj: | DMW - Deutsche Medizinische Wochenschrift. 135:2235-2238 |
| ISSN: | 1439-4413 0012-0472 |
| DOI: | 10.1055/s-0030-1267506 |
| Popis: | History and admission findings Due to a retroperitoneal hematoma after cardiac catheterization a 64 year-old woman received two concentrates of red blood cells. Within two hours after transfusion the patient developed acute dyspnoea, anxiety and shivering. Investigations Computertomography (CT) of the chest revealed a new bilateral, basally accented pulmonary edema. Pulmonary embolism was ruled out. A cardiac cause in terms of cardiogenic shock had been excluded by echocardiography and other non-invasive measurements. Moreover, no circulatory overload (transfusion-associated circulatory overload [TACO]) after transfusion was presented and the stable size of the retroperitoneal hematoma excluded haemorrhagic shock. Hence, the clinical pattern pointed towards a transfusion-related acute lung injury (TRALI). Treatment and course The patient was intubated and a catecholamine medication was initiated. The weaning process proceeded without complications and the patient was extubated after several days. In the following chest x-ray no pulmonary residuals were left. After two weeks the patient was transferred to a rehabilitation unit. Conclusion TRALI is a life-threatening and an often unconsidered complication after transfusion of plasma containing blood products. According to the criteria of the european haemovigilance networks (EHN-criteria), TRALI is diagnosed by clinical and radiological parameters. In case of suspicious TRALI the involved transfusion center has to be informed. By a crossmatch between donor plasma and recipient granulocytes the causal antibodies are detected in most cases. In 17% of cases no antibodies are detected. |
| Databáze: | OpenAIRE |
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