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Transfusion-Related Acute Lung Injury (TRALI) In Donor Kidney Transplantation Patient – A Case Report

Transfusion-Related Acute Lung Injury (TRALI) In Donor Kidney Transplantation Patient – A Case Report
Nur Samsu, Santoso Chandra, Djoko Wibisono, Rudi Supriyadi, Yenni Kandarini, Bonar M Marbun, Dharmeizar, E. Susalit.
Universitas Padjadjaran, The Indonesian Journal Of Nephrology And Hypertension Vol. 8 No. 2 April-Juni 2008
Bahasa Inggris
Universitas Padjadjaran, The Indonesian Journal Of Nephrology And Hypertension Vol. 8 No. 2 April-Juni 2008

Transfusion-related acute lung injury (TRALI) is defined as noncardiogenic pulmonary edema related to transfusion therapy. It is a potentially life-threatening, underrecognized and under-reported complication of transfusion. Symptoms usually begin within 1-2 hours up to 6 hours and severity may range from mild to severe (life threatening). Clinically indistinguishable from acute respiratory distress syndrome (ARDS). The diagnosis of TRALI relies on excluding other diagnoses and based primarily on clinical simptoms and signs, not laboratory findings. The minimum requirements for diagnosis of TRALI was occurrence of acute repiratory distress during or within 6 hrs of transfusion, absence of signs of circulatory overload, and radiographic evidence of bilateral pulmonary infiltrates. The pathogenesis of TRALI may be explained by a two-hit hypothesis, with the first hit being an underlying condition of the patient. The second hit may involve the presence of biologically active lipids or leucocyte antibodies in transfused blood component. No specific treatment for TRALI. Maintenance of hemodynamic status is the most beneficial and appropriate therapy. Ventilatory support and saline infusion are probably the only standard therapies for TRALI. We reported a 24 yaers old male-kidney related transplantasion donor patien with TRALI that occur approximately 2 hours after transfusion of pack red cell on day-3 of nephrectomy. Transfusion was indicated for patien because of acute bleeding. Patiens developed dyspnea, cyanosis, cough with pink frothy sputum, along with physical findings of bilateral pulmonary edema. The CXR examination showed bilateral pulmonary infiltrates. A patien was given intubation and ventilatory support and inproved with resolution of the pulmonary infiltrasion within the first 4 days.

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