Transfusion-related acute lung injury or acute chest syndrome of sickle cell disease? - A case report

• Published in: Canadian journal of anesthesia 2003-11, Vol.50 (9), p.895-899
• Main Authors: FIRTH, Paul G, TSURUTA, Yoshihiko, KAMATH, Yogish, DZIK, Walter H, OGILVY, Christopher S, PETERFREUND, Robert A
• Format: Article
• Language: English
• Subjects: Acute Disease; Anemia, Sickle Cell - complications; Anemia, Sickle Cell - therapy; Anemias. Hemoglobinopathies; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Diagnosis, Differential; Diseases of red blood cells; Erythrocyte Transfusion - adverse effects; Female; Hematologic and hematopoietic diseases; Humans; Lung - diagnostic imaging; Lung - physiopathology; Lungs; Medical sciences; Middle Aged; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Pulmonary Edema - complications; Pulmonary Edema - diagnosis; Respiratory Distress Syndrome, Adult - complications; Respiratory Distress Syndrome, Adult - diagnosis; Respiratory Distress Syndrome, Adult - etiology; Sickle cell anemia; Sickle cell disease; Syndrome; Tomography, X-Ray Computed; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Vascular Surgical Procedures - adverse effects
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/BF03018735

To describe how to differentiate transfusion-related acute lung injury from acute chest syndrome of sickle cell disease. A neurosurgical patient with sickle cell disease received two units of packed red blood cells postoperatively. Four hours later she developed progressive respiratory distress, diffuse geographical airspace disease and bilateral pulmonary edema. The patient recovered sufficiently to be transferred from the intensive care unit within four days. The temporal relationship to transfusion, features on computerized tomographic scan, and the rapid resolution of severe edema point to a diagnosis of transfusion related acute lung injury. Granulocyte or human leukocyte antigen antibodies in donor plasma may confirm a diagnosis of transfusion injury. The clinician should appreciate that erythrocyte transfusion to prevent or treat acute chest syndrome may cause transfusion related acute lung injury, a condition that mimics, exacerbates or possibly triggers the syndrome it was intended to treat.