Title: TRALI- Transfusion related lung injury
题目：TRALI－与输血相关的急性肺损伤
Author 作者: Feras Khan

Background 背景
Acute lung injury develops within 6 hours after transfusion of 1 or more units of blood or blood components.
急性肺损伤发生在输1个或多个单位的血液或血液成分后6小时内。
Increased risk with greater number of transfusions
随输血量增加，风险系数变大
Incidence is 1 in 4000
发病率为4000分之一

Definition 定义
Acute onset
起病急
Hypoxemia (PaO2/FiO2 < 300 mm Hg)
低氧血症（PaO2/FiO2 < 300 mm Hg）
Bilateral pulmonary opacities on chest x-ray
胸部X射线显示双侧肺实变影
Absence of left atrial hypertension
无左心房高压

Pathogenesis 发病机制

Two-hit hypothesis: first hit is underlying patient factors causing adherence of neutrophils to the pulmonary endothelium; second hit is caused by mediators in the blood transfusion that activate the neutrophils and endothelial cells.
二次损伤假说：首先造成病人相关因素，导致中性粒细胞粘附于肺血管内皮细胞；然后由输血过程产生的介质激活中性粒细胞和内皮细胞。
Differential 鉴别诊断
Can be confused or overlap with TACO or transfusion-associated volume/circulatory overload, which presents similarly but has evidence of increased BNP, CVP, pulmonary wedge pressure, and left sided heart pressures. Patients with TACO tend to improve with diuretic treatment
可以与输血相关的容量／循环超负荷（TACO）混淆或有重叠，TACO表现虽类式，但有BNP， CVP ，肺动脉嵌顿压，左侧心脏的压力增加的证据。 TACO患者通常在利尿剂治疗后改善。

Supportive tests 相关检查
Echocardiogram 超声心动图
BNP (tends to be low) BNP （往往是低的）
Transient leukopenia 短暂白细胞减少

Treatment 治疗
Supportive care 支持治疗
Lung protective ventilation strategies 肺保护性通气措施
Fluid restrictive strategy 限制流体量
Aspirin (shown to be helpful in animal studies)
阿司匹林（在动物研究中证明是有助益）
Pre-washing of stored RBCs prior to transfusion
在输储存红细胞前进行冲洗
Decrease the amount of transfusions!
•减少输血量！
References
Lancet. 2013 Sep 14;382(9896):984-94. doi: 10.1016/S0140-6736(12)62197-7. Epub 2013 May 1.