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Tung JP, Chiaretti S, Dean MM, Sultana AJ, Reade MC, Fung YL. Transfusion-related acute lung injury (TRALI): Potential pathways of development, strategies for prevention and treatment, and future research directions. Blood Rev 2022; 53:100926. [DOI: 10.1016/j.blre.2021.100926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/01/2021] [Accepted: 12/30/2021] [Indexed: 02/08/2023]
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Peptide inhibition of acute lung injury in a novel two-hit rat model. PLoS One 2021; 16:e0259133. [PMID: 34710157 PMCID: PMC8553074 DOI: 10.1371/journal.pone.0259133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/14/2021] [Indexed: 12/19/2022] Open
Abstract
Acute lung injury (ALI) often causes severe trauma that may progress to significant morbidity and mortality. ALI results from a combination of the underlying clinical condition of the patient (e.g., inflammation) with a secondary insult such as viral pneumonia or a blood transfusion. While the secondary insult may be variable, the rapidly progressive disease process leading to pulmonary failure is typically mediated by an overwhelming innate immunological or inflammatory reaction driven by excessive complement and neutrophil-mediated inflammatory responses. We recently developed a ‘two-hit’ ALI rat model mediated by lipopolysaccharide followed by transfusion of incompatible human erythrocytes resulting in complement activation, neutrophil-mediated ALI and free DNA in the blood indicative of neutrophil extracellular trap formation. The objective of this study was to evaluate the role of peptide inhibitor of complement C1 (RLS-0071), a classical complement pathway inhibitor and neutrophil modulator in this animal model. Adolescent male Wistar rats were infused with lipopolysaccharide followed by transfusion of incompatible erythrocytes in the presence or absence of RLS-0071. Blood was collected at various time points to assess complement C5a levels, free DNA and cytokines in isolated plasma. Four hours following erythrocyte transfusion, lung tissue was recovered and assayed for ALI by histology. Compared to animals not receiving RLS-0071, lungs of animals treated with a single dose of RLS-0071 showed significant reduction in ALI as well as reduced levels of C5a, free DNA and inflammatory cytokines in the blood. These results demonstrate that RLS-0071 can modulate neutrophil-mediated ALI in this novel rat model.
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Safety profile and impact of low-titer group O whole blood for emergency use in trauma. J Trauma Acute Care Surg 2020; 88:87-93. [PMID: 31464874 DOI: 10.1097/ta.0000000000002498] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Following US military implementation of a cold-stored whole blood program, several US trauma centers have begun incorporating uncrossmatched, group O cold-stored whole blood into civilian trauma resuscitation. We set out to evaluate the safety profile, transfusion reactions events, and impact of low-titer group O whole blood (LTO-WB) at our center. METHODS In November 2017, we added LTO-WB to each of our helicopters and to our emergency department (ED) refrigerator, alongside that of existing red blood cells and plasma. We collected information on all patients with trauma receiving prehospital or ED transfusion of uncrossed, emergency release blood products between November 2017 and June 2018. Patients were divided into those receiving any LTO-WB and those receiving only red blood cell and or plasma (COMP). Serial hemolysis panels were obtained at 3 hours, 24 hours, and 48 hours. All data were run using STATA 12.1. Statistical significance was set at p < 0.05. RESULTS One hundred ninety-eight patients received LTO-WB and 152 patients received COMP. There were no differences in age, sex, or mechanism. The LTO-WB patients had higher chest Abbreviated Injury Scale scores (median, 3 vs. 2; p = 0.027), as well as worse arrival base excess (median, -7 vs. -5; p = 0.014) and lactate (5.1 vs. 3.5; p < 0.001). The LTO-WB patients received less post-ED blood products than the COMP patients (median, 0 vs. 3; p = 0.001). There was no difference in survival (LTO-WB, 73%; COMP, 74%; p = 0.805). There were only two suspected transfusion reactions, both in the COMP group (p = 0.061). There was no difference in hemolysis panel values. Controlling for age, severity of injury, and prehospital physiology, LTO-WB was associated with a 53% reduction in post-ED blood product transfusion (odds ratio, 0.47; 0.23-0.94 95% CI; p = 0.033) and two-fold increase in likelihood of survival (odds ratio, 2.19; 1.01-4.76 95% CI; p = 0.047). CONCLUSION Low-titer group O whole blood has similar evidence of laboratory hemolysis, similar transfusion reaction rates, and is associated with a reduction in post-ED transfusions and increase likelihood of survival. LEVEL OF EVIDENCE Therapeutic, Level II.
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Abstract
BACKGROUND Cold-stored whole blood (CWB) provides a balance of red blood cells, plasma, and platelets in less anticoagulant volume than standard blood component therapy (BCT). We hypothesize that patients receiving CWB along with BCT have improved survival compared with patients receiving only BCT. METHODS We performed a dual-center case-match study of trauma patients who received CWB and BCT at two urban, Level-I Trauma Centers. Criteria to receive CWB included boys 16 years of older, women older than 50 years, SBP less than 90 mm Hg, and identifiable source of hemorrhage. We performed a 2:1 propensity match against any trauma patient who received 1 unit or greater of packed red cells during their initial trauma bay resuscitation. Endpoints included trauma bay mortality, 30-day mortality, laboratory values at 4 hours and 24 hours, and overall blood product utilization. Comparisons were made with Wilcoxon-ranked sum and Fisher's exact test, p less than 0.05 was significant. RESULTS Between both institutions, a total of 107 patients received CWB during the study period with 91 being matched to 182 BCT patients for analysis. Hemodynamic parameters of the patients in both groups at the time of presentation were similar. The CWB patients had higher mean hemoglobin (10 ± 2 g/dL vs. 11 ± 2 g/dL; p < 0.001) and hematocrit (29.2 ± 6.1% vs. 32.1 ± 5.8%; p < 0.001) at 24 hours. Importantly, trauma bay mortality was less in CWB patients (8.8% vs. 2.2%;p = 0.039). Thirty-day mortality was not different in CWB patients, and there were no differences in the total amount of blood products transfused at the 4-hour and 24-hour periods. CONCLUSION Cold-stored whole blood offers the benefit of a balanced resuscitation with improved trauma bay survival and higher mean hemoglobin at 24 hours. A larger, prospective study is needed to determine whether it has a longer-term survival benefit for severely injured patients. LEVEL OF EVIDENCE Therapeutic, level III.
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Acute Respiratory Distress Syndrome in Cancer Patients. ONCOLOGIC CRITICAL CARE 2020. [PMCID: PMC7123590 DOI: 10.1007/978-3-319-74588-6_48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Acute respiratory distress syndrome (ARDS) is a heterogeneous form of acute, diffuse lung injury that is characterized by dysregulated inflammation, increased alveolar-capillary interface permeability, and non-cardiogenic pulmonary edema. In the general population, the incidence and mortality associated with ARDS over the last two decades have steadily declined in parallel with optimized approaches to pneumonia and other underlying causes of ARDS as well as increased utilization of multimodal treatment strategies that include lung-protective ventilation. In the cancer settings, significant declines in the incidence and mortality of ARDS over the past two decades have also been reported, although these rates remain significantly higher than those in the general population. Epidemiologic studies identify infection, including disseminated fungal pneumonias, as a major underlying cause of ARDS in the cancer setting. More than half of cancer patients who develop ARDS will not survive to hospital discharge. Those who do survive often face a protracted and often incomplete recovery, resulting in significant long-term physical, psychological, and cognitive sequelae. The residual organ dysfunction and poor functional status after ARDS may delay or preclude subsequent cancer treatments. As such, close collaboration between the critical care physicians and oncology team is essential in identifying and reversing the underlying causes and optimizing treatments for cancer patients with ARDS. This chapter reviews the diagnosis and common causes of ARDS in cancer and gives an update on the general management principles for cancer patients with ARDS in the ICU.
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Wu WW, Zhang WY, Zhang WH, Yang L, Deng XQ, Ou MC, Yang YX, Liu HB, Zhu T. Survival analysis of intraoperative blood salvage for patients with malignancy disease: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e16040. [PMID: 31277097 PMCID: PMC6635293 DOI: 10.1097/md.0000000000016040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Intraoperative blood salvage as a blood-saving strategy has been widely used in surgery. Considering its theoretic risk of malignant tumor cells being reinfused and the corresponding blood metastases, the safety of intraoperative blood salvage in cancer surgery remains controversial. METHODS Following the Preferred Reporting Items for Systemic Review and Meta-Analysis (PRISMA), we searched the Cochrane Library, MEDLINE and EMBASE to November 2017. We included only studies comparing intraoperative blood salvage with allogeneic blood transfusion. RESULTS This meta-analysis included 9 studies with 4354 patients with 1346 patients in the intraoperative blood salvage group and 3008 patients in the allogeneic blood transfusion group. There were no significant differences in the 5-year overall survival outcome (odds ratio [OR] 1.12; 95% confidence interval [CI], 0.80-1.58), 5-year disease-free survival outcome (OR 1.08; 95% CI 0.86-1.35), or 5-year recurrence rate (OR 0.86; 95% CI 0.71-1.05) between the 2 study groups. Subgroup analysis also showed no significant differences in the 5-year overall survival outcome (OR 0.97; 95% CI 0.57-1.67) of hepatocellular carcinoma patients in liver transplantation. CONCLUSIONS For patients with malignant disease, intraoperative blood salvage did not increase the tumor recurrence rate and had comparable survival outcomes with allogeneic blood transfusion.
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Affiliation(s)
- Wei-Wei Wu
- Department of Anesthesiology, West China Hospital
| | - Wei-Yi Zhang
- Department of Anesthesiology, West China Hospital
| | - Wei-Han Zhang
- Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Collaborative Innovation Center for Biotherapy, Sichuan University, Chengdu, Sichuan, China
| | - Lei Yang
- Department of Anesthesiology, West China Hospital
| | | | - Meng-Chan Ou
- Department of Anesthesiology, West China Hospital
| | - Yao-Xin Yang
- Department of Anesthesiology, West China Hospital
| | - Hai-Bei Liu
- Department of Anesthesiology, West China Hospital
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital
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The ATP-gated P2X 1 ion channel contributes to the severity of antibody-mediated Transfusion-Related Acute Lung Injury in mice. Sci Rep 2019; 9:5159. [PMID: 30914724 PMCID: PMC6435740 DOI: 10.1038/s41598-019-41742-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/11/2019] [Indexed: 12/19/2022] Open
Abstract
The biological responses that control the development of Transfusion-Related Acute Lung Injury (TRALI), a serious post-transfusion respiratory syndrome, still need to be clarified. Since extracellular nucleotides and their P2 receptors participate in inflammatory processes as well as in cellular responses to stress, we investigated the role of the ATP-gated P2X1 cation channel in antibody-mediated TRALI. The effects of NF449, a selective P2X1 receptor (P2RX1) antagonist, were analyzed in a mouse two-hit model of TRALI. Mice were primed with lipopolysaccharide (LPS) and 24 h later challenged by administrating an anti-MHC I antibody. The selective P2RX1 antagonist NF449 was administrated before the administration of LPS and/or the anti-MHC I antibody. When given before antibody administration, NF449 improved survival while maximal protection was achieved when NF449 was also administrated before the sensitization step. Under this later condition, protein contents in bronchoalveolar lavages were dramatically reduced. Cell depletion experiments indicated that monocytes/macrophages, but not neutrophils, contribute to this effect. In addition, the reduced lung periarteriolar interstitial edemas in NF449-treated mice suggested that P2RX1 from arteriolar smooth muscle cells could represent a target of NF449. Accordingly, inhibition of TRPC6, another cation channel expressed by smooth muscle cells, also reduced TRALI-associated pulmonary interstitial and alveolar edemas. These data strongly suggest that cation channels like P2RX1 or TRPC6 participate to TRALI pathological responses.
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Sung TY, Jee YS, Lee SJ, You HJ, Jeong KS, Kang PS. Transfusion-related acute lung injury in a parturient diagnosed with myelodysplastic syndrome - A case report -. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.1.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Tae-Yun Sung
- Department of Anesthesiology and Pain Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Young Seok Jee
- Department of Anesthesiology and Pain Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Seok-jin Lee
- Department of Anesthesiology and Pain Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Hwang Ju You
- Department of Anesthesiology and Pain Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Ki Soon Jeong
- Department of Anesthesiology and Pain Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Po-Soon Kang
- Department of Anesthesiology and Pain Medicine, Konyang University College of Medicine, Daejeon, Korea
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Robinson BRH, Cohen MJ, Holcomb JB, Pritts TA, Gomaa D, Fox EE, Branson RD, Callcut RA, Cotton BA, Schreiber MA, Brasel KJ, Pittet JF, Inaba K, Kerby JD, Scalea TM, Wade CE, Bulger EM. Risk Factors for the Development of Acute Respiratory Distress Syndrome Following Hemorrhage. Shock 2018; 50:258-264. [PMID: 29194339 PMCID: PMC5976504 DOI: 10.1097/shk.0000000000001073] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) study evaluated the effects of plasma and platelets on hemostasis and mortality after hemorrhage. The pulmonary consequences of resuscitation strategies that mimic whole blood, remain unknown. METHODS A secondary analysis of the PROPPR study was performed. Injured patients predicted to receive a massive transfusion were randomized to 1:1:1 versus 1:1:2 plasma-platelet-red blood cell ratios at 12 Level I North American trauma centers. Patients with survival >24 h, an intensive care unit (ICU) stay, and a recorded PaO2/FiO2 (P/F) ratio were included. Acute respiratory distress syndrome (ARDS) was defined as a P/F ratio < 200, with bilateral pulmonary infiltrates, and adjudicated by investigators. RESULTS Four hundred fifty-four patients were reviewed (230 received 1:1:1, 224 1:1:2). Age, sex, injury mechanism, and regional abbreviated injury scale (AIS) scores did not differ between cohorts. Tidal volume, positive end-expiratory pressure, and lowest P/F ratio did not differ. No significant differences in ARDS rates (14.8% vs. 18.4%), ventilator-free (24 vs. 24) or ICU-free days (17.5 vs. 18), hospital length of stay (22 days vs. 18 days), or 30-day mortality were found (28% vs. 28%). ARDS was associated with blunt injury (OR 3.61 [1.53-8.81] P < 0.01) and increasing chest AIS (OR 1.40 [1.15-1.71] P < 0.01). Each 500 mL of crystalloid infused during hours 0 to 6 was associated with a 9% increase in the rate of ARDS (OR 1.09 [1.04-1.14] P < 0.01). Blood given at 0 to 6 or 7 to 24 h were not risk factors for lung injury. CONCLUSION Acute crystalloid exposure, but not blood products, is a potentially modifiable risk factor for the prevention of ARDS following hemorrhage.
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Affiliation(s)
- Bryce RH Robinson
- Division of Trauma and Critical Care, Department of Surgery, School of Medicine, University of Washington, Seattle, WA
| | - Mitchell J Cohen
- Department of Surgery, Denver Health Medical Center, University of Colorado, Denver, CO
| | - John B Holcomb
- Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, Houston, TX
| | - Timothy A Pritts
- Division of Trauma and Critical Care, Department of Surgery, University of Cincinnati, Cincinnati, OH
| | - Dina Gomaa
- Division of Trauma and Critical Care, Department of Surgery, University of Cincinnati, Cincinnati, OH
| | - Erin E Fox
- Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, Houston, TX
| | - Richard D Branson
- Division of Trauma and Critical Care, Department of Surgery, University of Cincinnati, Cincinnati, OH
| | - Rachael A Callcut
- Division of General Surgery, Department of Surgery, School of Medicine, University of California San Francisco, San Francisco, CA
| | - Bryan A Cotton
- Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, Houston, TX
| | - Martin A Schreiber
- Division of Trauma, Critical Care and Acute Care Surgery, School of Medicine, Oregon Health & Science University, Portland, OR
| | - Karen J Brasel
- Division of Trauma, Critical Care and Acute Care Surgery, School of Medicine, Oregon Health & Science University, Portland, OR
| | - Jean-Francois Pittet
- Division of Critical Care and Perioperative Medicine, Department of Anesthesiology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Kenji Inaba
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, CA
| | - Jeffery D Kerby
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Thomas M Scalea
- R Adams Cowley Shock Trauma Center, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD
| | - Charlie E Wade
- Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, University of Texas Health Science Center at Houston, Houston, TX
| | - Eileen M Bulger
- Division of Trauma and Critical Care, Department of Surgery, School of Medicine, University of Washington, Seattle, WA
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Thromboelastometry Identified Alteration of Clot Stabilization and Factor XIII Supplementation Need in a Patient with Decompensated Liver Disease Undergoing Liver Biopsy. Case Rep Gastrointest Med 2018; 2018:6360543. [PMID: 30228917 PMCID: PMC6136510 DOI: 10.1155/2018/6360543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/05/2018] [Accepted: 07/31/2018] [Indexed: 11/17/2022] Open
Abstract
Liver disease has been considered the prototype of hemorrhagic disease. Disorder in any component of coagulation system can lead to hemorrhage. Deficiency of factor XIII may impair clot strength and clot stabilization and can be accessed by thromboelastometry. We report a case of a patient with a rapid evolution of liver disease who underwent a liver biopsy. Thromboelastometry was performed, evidencing impairment of clot stability. This clotting disorder was corrected with factor XIII concentrate after unsuccessful administration of antifibrinolytic drugs and hepatic biopsy was performed without hemorrhagic complications. Case Presentation. We report the case of a previously healthy 38-year-old man, who presented to our emergency department with clinical signs of rapid progression of acute liver failure. The laboratory tests revealed platelets of 142x103/mm3, plasma fibrinogen concentration of 221 mg/dl, increased international nationalized ratio (INR 1.9), total bilirubin of 3.9mg/dl, direct bilirubin of 2.3mg/dl, ALT 751U/l, and AST 540U/l without acute bleeding. A liver biopsy was indicated. Based on the results of the thromboelastometry, Tranexamic Acid was administered to correct hyperfibrinolysis followed by factor XIII concentrate to correct factor XIII deficiency. Thromboelastometry was normal despite conventional coagulation tests were still altered. So, liver biopsy was performed with no signs of bleeding and without need of further transfusion. Conclusion. Thromboelastometry may be considered a useful, feasible, and safe tool to monitor and manage coagulopathy in patients with liver disease, with the potential advantage of helping avoid unnecessary transfusion in such patients.
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Abstract
Traumatic hemorrhage is the leading cause of preventable death after trauma. Early transfusion of plasma and balanced transfusion have been shown to optimize survival, mitigate the acute coagulopathy of trauma, and restore the endothelial glycocalyx. There are a myriad of plasma formulations available worldwide, including fresh frozen plasma, thawed plasma, liquid plasma, plasma frozen within 24 h, and lyophilized plasma (LP). Significant equipoise exists in the literature regarding the optimal plasma formulation. LP is a freeze-dried formulation that was originally developed in the 1930s and used by the American and British military in World War II. It was subsequently discontinued due to risk of disease transmission from pooled donors. Recently, there has been a significant amount of research focusing on optimizing reconstitution of LP. Findings show that sterile water buffered with ascorbic acid results in decreased blood loss with suppression of systemic inflammation. We are now beginning to realize the creation of a plasma-derived formulation that rapidly produces the associated benefits without logistical or safety constraints. This review will highlight the history of plasma, detail the various types of plasma formulations currently available, their pathophysiological effects, impacts of storage on coagulation factors in vitro and in vivo, novel concepts, and future directions.
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Smith NK, Kim S, Hill B, Goldberg A, DeMaria S, Zerillo J. Transfusion-Related Acute Lung Injury (TRALI) and Transfusion-Associated Circulatory Overload (TACO) in Liver Transplantation: A Case Report and Focused Review. Semin Cardiothorac Vasc Anesth 2017; 22:180-190. [DOI: 10.1177/1089253217736298] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Liver transplantation (LT) is a complex procedure in a patient with multi-organ system dysfunction and coagulation defects. The surgical procedure involves dissection, major vessel manipulation, and pathophysiologic effects of graft storage and reperfusion. As a result, LT frequently involves significant hemorrhage. Subsequent massive transfusion carries high risk of transfusion-associated complications. Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are the leading causes of transfusion associated mortality. In this case report and focused review, we present data that suggest that patients undergoing liver transplantation may be at higher risk for TRALI and TACO than the general population. Anesthesiologists can play a role in decreasing these risks by increasing recognition and reporting of TRALI and TACO, using point of care testing with thromboelastography to guide and decrease transfusion, and considering alternatives to traditional blood products like solvent/detergent plasma.
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Affiliation(s)
- Natalie K. Smith
- The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Sang Kim
- The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Bryan Hill
- The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Andrew Goldberg
- The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Samuel DeMaria
- The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Jeron Zerillo
- The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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Bommiasamy AK, Schreiber MA. Damage control resuscitation: how to use blood products and manage major bleeding in trauma. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/voxs.12353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- A. K. Bommiasamy
- Department of Surgery; Oregon Health & Science University; Portland OR USA
| | - M. A. Schreiber
- Department of Surgery; Oregon Health & Science University; Portland OR USA
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Gill SE, Nadler ST, Li Q, Frevert CW, Park PW, Chen P, Parks WC. Shedding of Syndecan-1/CXCL1 Complexes by Matrix Metalloproteinase 7 Functions as an Epithelial Checkpoint of Neutrophil Activation. Am J Respir Cell Mol Biol 2017; 55:243-51. [PMID: 26934670 DOI: 10.1165/rcmb.2015-0193oc] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Although neutrophils play critical roles in innate immunity, in excess these cells cause severe tissue damage. Thus, neutrophil activation must be tightly regulated to prevent indiscriminant damage. Previously, we reported that mice lacking matrix metalloproteinase (MMP) 7 are protected from lung injury owing to markedly impaired neutrophil movement from the interstitium into mucosal lumenal spaces. This phenotype resulted from a lack of MMP7 shedding of syndecan-1, a heparan sulfate proteoglycan that carries the neutrophil chemokine CXCL1 as cargo. Here, we assessed if shedding syndecan-1/CXCL1 complexes affects neutrophil activation. Whereas injured monolayers of wild-type alveolar type II cells potently stimulated neutrophil activation, as gauged by release of myeloperoxidase, cells from Mmp7(-/-) or syndecan-1-null (Sdc1(-/-)) mice or human cells with MMP7 knockdown did not. In vivo, we observed reduced myeloperoxidase release relative to neutrophil numbers in bleomycin-injured Mmp7(-/-) and Sdc1(-/-) mice. Furthermore, we determined that soluble syndecan-1 directly stimulated neutrophil activation in the absence of cellular damage. These data indicate that MMP7 shedding of syndecan-1/CXCL1 complexes functions as a checkpoint that restricts neutrophil activation at sites of epithelial injury.
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Affiliation(s)
- Sean E Gill
- 1 Center for Lung Biology and Department of.,2 Centre for Critical Illness Research, Western University, London, Ontario, Canada
| | | | | | - Charles W Frevert
- 1 Center for Lung Biology and Department of.,3 Comparative Medicine, University of Washington, Seattle, Washington
| | - Pyong Woo Park
- 4 Department of Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Peter Chen
- 1 Center for Lung Biology and Department of.,5 Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - William C Parks
- 1 Center for Lung Biology and Department of.,5 Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, California
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Smigiel KS, Parks WC. Matrix Metalloproteinases and Leukocyte Activation. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2017; 147:167-195. [PMID: 28413028 DOI: 10.1016/bs.pmbts.2017.01.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
As their name implies, matrix metalloproteinases (MMPs) are thought to degrade extracellular matrix proteins, a function that is indeed performed by some members. However, regardless of their cell source, matrix degradation is not the only function of these enzymes. Rather, individual MMPs have been shown to regulate specific immune processes, such as leukocyte influx and migration, antimicrobial activity, macrophage activation, and restoration of barrier function, typically by processing a range of nonmatrix protein substrates. Indeed, MMP expression is low under steady-state conditions but is markedly induced during inflammatory processes including infection, wound healing, and cancer. Increasing research is showing that MMPs are not just a downstream consequence of a generalized inflammatory process, but rather are critical factors in the overall regulation of the pattern, type, and duration of immune responses. This chapter outlines the role of leukocytes in tissue remodeling and describes recent progress in our understanding of how MMPs alter leukocyte activity.
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Affiliation(s)
- Kate S Smigiel
- Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - William C Parks
- Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
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Srettabunjong S, Limgitisupasin W. Severe acute hemorrhagic pancreatitis secondary to cholelithiasis as a rare cause of sudden unexpected death in medico-legal case: A case report. Medicine (Baltimore) 2016; 95:e4680. [PMID: 27559973 PMCID: PMC5400340 DOI: 10.1097/md.0000000000004680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Acute pancreatitis (AP) is an uncommon disease with a wide clinical course varying from mild and self-limiting to severe with eventual death. However, death caused by AP is rare. Most cases of AP reported in the English-language literature are based on clinical data; few are medico-legal studies. CASE PRESENTATION The author recently experienced a case of sudden unexpected death in a young man caused by extensive severe hemorrhagic AP secondary to cholelithiasis, not chronic alcoholism, which is a much more prominent etiology of AP in medico-legal perspectives. The deceased had complained of dizziness, nausea, and fatigue without significant abdominal pain for about 1 week and received some home medications for symptomatic treatment including an antibiotic drug from a clinic just 2 days prior to his death. He had complained of lower extremity weakness, intense thirst, and subsequently collapsed and was brought to a nearby hospital where he was pronounced dead shortly after his admission following unsuccessful advanced cardiopulmonary resuscitation attempts. CONCLUSION This case is herein reported with an extensive review of the pertinent literature to highlight the findings of the case and raise awareness within the medico-legal profession and also the medical profession.
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Affiliation(s)
- Supawon Srettabunjong
- Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Correspondence: Supawon Srettabunjong, Department of Forensic Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand (e-mail: )
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Nagura Y, Tsuno NH, Kano K, Inoue A, Aoki J, Hirowatari Y, Kaneko M, Kurano M, Matsuhashi M, Ohkawa R, Tozuka M, Yatomi Y, Okazaki H. Regulation of the lysophosphatidylserine and sphingosine 1-phosphate levels in autologous whole blood by the pre-storage leukocyte reduction. Transfus Med 2016; 26:365-372. [DOI: 10.1111/tme.12326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 05/14/2016] [Accepted: 05/24/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Y. Nagura
- Department of Transfusion Medicine; The University of Tokyo Hospital; Tokyo Japan
- Analytical Laboratory Chemistry, Graduate School of Health Care Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - N. H. Tsuno
- Department of Transfusion Medicine; The University of Tokyo Hospital; Tokyo Japan
| | - K. Kano
- Graduate School of Pharmaceutical Sciences; Tohoku University; Miyagi Japan
| | - A. Inoue
- Graduate School of Pharmaceutical Sciences; Tohoku University; Miyagi Japan
| | - J. Aoki
- Graduate School of Pharmaceutical Sciences; Tohoku University; Miyagi Japan
| | - Y. Hirowatari
- Laboratory Sciences, Department of Health Sciences; Saitama Prefectural University; Saitama Japan
| | - M. Kaneko
- Department of Clinical Laboratory; The University of Tokyo Hospital; Tokyo Japan
| | - M. Kurano
- Department of Clinical Laboratory; The University of Tokyo Hospital; Tokyo Japan
| | - M. Matsuhashi
- Department of Transfusion Medicine; The University of Tokyo Hospital; Tokyo Japan
- Laboratory Sciences, Department of Health Sciences; Saitama Prefectural University; Saitama Japan
| | - R. Ohkawa
- Analytical Laboratory Chemistry, Graduate School of Health Care Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - M. Tozuka
- Analytical Laboratory Chemistry, Graduate School of Health Care Sciences; Tokyo Medical and Dental University; Tokyo Japan
| | - Y. Yatomi
- Department of Clinical Laboratory; The University of Tokyo Hospital; Tokyo Japan
| | - H. Okazaki
- Department of Transfusion Medicine; The University of Tokyo Hospital; Tokyo Japan
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Cognasse F, Aloui C, Anh Nguyen K, Hamzeh-Cognasse H, Fagan J, Arthaud CA, Eyraud MA, Sebban M, Fromont E, Pozzetto B, Laradi S, Garraud O. Platelet components associated with adverse reactions: predictive value of mitochondrial DNA relative to biological response modifiers. Transfusion 2015; 56:497-504. [DOI: 10.1111/trf.13373] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/23/2015] [Accepted: 08/31/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Fabrice Cognasse
- Etablissement Français du Sang Auvergne-Loire; Saint-Étienne
- GIMAP-EA3064; Université de Lyon; Saint-Étienne France
| | - Chaker Aloui
- GIMAP-EA3064; Université de Lyon; Saint-Étienne France
| | | | | | - Jocelyne Fagan
- Etablissement Français du Sang Auvergne-Loire; Saint-Étienne
| | | | | | - Marc Sebban
- Laboratoire Hubert Curien; UMR CNRS 5516; Saint-Étienne
| | - Elisa Fromont
- Laboratoire Hubert Curien; UMR CNRS 5516; Saint-Étienne
| | | | - Sandrine Laradi
- Etablissement Français du Sang Auvergne-Loire; Saint-Étienne
- GIMAP-EA3064; Université de Lyon; Saint-Étienne France
| | - Olivier Garraud
- GIMAP-EA3064; Université de Lyon; Saint-Étienne France
- INTS-Institut National de la Transfusion Sanguine; Paris France
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Bogert JN, Harvin JA, Cotton BA. Damage Control Resuscitation. J Intensive Care Med 2014; 31:177-86. [PMID: 25385695 DOI: 10.1177/0885066614558018] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/09/2014] [Indexed: 01/26/2023]
Abstract
Resuscitation of the hemorrhaging patient has undergone significant changes in the last decade resulting in the concept of damage control resuscitation (DCR). Hemostatic resuscitation aims to address the physiologic derangements found in the hemorrhaging patient, namely coagulopathy, acidosis, and hypothermia. Strategies to achieve this are permissive hypotension, high ratio of plasma and platelet transfusion to packed red blood cell transfusion, and limitation of crystalloid administration. Damage control surgery aims for early hemorrhage control and minimizing operative time by delaying definitive repair until the patient's physiologic status has normalized. Together these strategies constitute DCR and have led to improved outcomes for hemorrhaging patients over the last 2 decades. Recently, DCR has been augmented by both pharmacologic and laboratory adjuncts to improve the care of the hemorrhaging patient. These include thrombelastography as a detailed measure of the clotting cascade, tranexamic acid as an antifibrinolytic, and the procoagulant activated factor VII. In this review, we discuss the strategies that makeup DCR, their adjuncts, and how they fit into the care of the hemorrhaging patient.
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Affiliation(s)
- James N Bogert
- Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA
| | - John A Harvin
- Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA
| | - Bryan A Cotton
- Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA
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Al-Riyami AZ, Al-Hashmi S, Al-Arimi Z, Wadsworth LD, Al-Rawas A, Al-Khabori M, Daar S. Recognition, Investigation and Management of Acute Transfusion Reactions: Consensus guidelines for Oman. Sultan Qaboos Univ Med J 2014; 14:e306-e318. [PMID: 25097764 PMCID: PMC4117654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 03/10/2014] [Accepted: 04/03/2014] [Indexed: 06/03/2023] Open
Abstract
The recognition and management of transfusion reactions (TRs) are critical to ensure patient safety during and after a blood transfusion. Transfusion reactions are classified into acute transfusion reactions (ATRs) or delayed transfusion reactions, and each category includes different subtypes. Different ATRs share common signs and symptoms which can make categorisation difficult at the beginning of the reaction. Moreover, TRs are often under-recognised and under-reported. To ensure uniform practice and safety, it is necessary to implement a national haemovigilance system and a set of national guidelines establishing policies for blood transfusion and for the detection and management of TRs. In Oman, there are currently no local TR guidelines to guide physicians and hospital blood banks. This paper summarises the available literature and provides consensus guidelines to be used in the recognition, management and reporting of ATRs.
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Affiliation(s)
- Arwa Z. Al-Riyami
- Departments of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sabria Al-Hashmi
- Department of Haematology & Blood Transfusion, Royal Hospital, Muscat, Oman
| | - Zainab Al-Arimi
- Directorate of Blood Services, Ministry of Health, Muscat, Oman
| | - Louis D. Wadsworth
- Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Shahina Daar
- Department of Haematology, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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Randelli F, D'Anchise R, Ragone V, Serrao L, Cabitza P, Randelli P. Is the newest fibrin sealant an effective strategy to reduce blood loss after total knee arthroplasty? A randomized controlled study. J Arthroplasty 2014; 29:1516-20. [PMID: 24674732 DOI: 10.1016/j.arth.2014.02.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 01/07/2014] [Accepted: 02/17/2014] [Indexed: 02/01/2023] Open
Abstract
An RCT was conducted to ascertain whether, compared to control management, topical application of a novel fibrin sealant (Evicel, J&J) in patients undergoing primary TKA reduces peri-operative blood loss. Sixty-two patients were randomized to receive topical application of Evicel (N = 31) or not (N = 31). The mean total blood loss was 1.9L(± 0.7) in the control group and 1.8L(± 0.5) in the treatment group (P = 0.4). The transfusion rate was 32.3% in the control group and 25.8% in the treatment group (P = 0.5). The transfusion rate decreased linearly with increasing preoperative Hb levels in the treatment group (P = 0.005). The results of this study suggest that topical application of this novel fibrin sealant doesn't reduce perioperative blood loss and the need for allogeneic blood transfusion.
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Affiliation(s)
- Filippo Randelli
- IRCCS, Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Vincenza Ragone
- IRCCS, Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luca Serrao
- IRCCS, Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paolo Cabitza
- IRCCS, Policlinico San Donato, San Donato Milanese, Milan, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | - Pietro Randelli
- IRCCS, Policlinico San Donato, San Donato Milanese, Milan, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
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Babaev A, Pozzi F, Hare G, Zhang H. Storage of Red Blood Cells and Transfusion-Related Acute Lung Injury. ACTA ACUST UNITED AC 2014; 1. [PMID: 28066804 DOI: 10.15406/jaccoa.2014.01.00002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Transfusion-related acute lung injury (TRALI) is a major complication post-transfusion. A consensus definition of TRALI has been recently established to improve diagnosis but the pathogenesis of TRALI is yet to be understood. Although the antibody-mediated two-hit model of TRALI is the classical narrative, increasing evidence of the probable implications of prolonged storage of blood provides novel mechanisms towards storage lesion- the potentially injurious cellular and biochemical changes that occur in stored red blood cells. Red blood cell-derived lipids and micro vesicles may have been playing an important role in the development of TRALI. This article will provide a brief overview of the current understanding of TRALI and then discuss the implications and the potential mechanisms by which stored red blood cells may lead to TRALI.
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Affiliation(s)
- Arkady Babaev
- Department of Anesthesia and Department of Physiology, University of Toronto, Canada
| | - Federico Pozzi
- Department of Anesthesia and Department of Physiology, University of Toronto, Canada
| | - Gregory Hare
- Department of Anesthesia and Department of Physiology, University of Toronto, Canada
| | - Haibo Zhang
- Department of Anesthesia and Department of Physiology, University of Toronto, Canada
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Tanaka S, Hayashi T, Tani Y, Hirayama F. Removal of biological response modifiers associated with platelet transfusion reactions by columns containing adsorption beads. Transfusion 2014; 54:1790-7. [PMID: 24417744 DOI: 10.1111/trf.12542] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 11/06/2013] [Accepted: 11/15/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND Biological response modifiers (BRMs), such as soluble CD40 ligand (sCD40L); regulated upon activation, normal T-cell expressed, and secreted (RANTES); and transforming growth factor-β1 (TGF-β1), are released from platelets (PLTs) during storage and may trigger adverse effects after PLT transfusion. Although washing PLTs is effective at reducing the level of BRMs and the incidence of transfusion reactions, the washing procedure is time-consuming and may induce PLT activation. Furthermore, some BRMs continue to accumulate during the storage of washed PLTs. A method to remove BRMs using adsorbent columns has not yet been developed. STUDY DESIGN AND METHODS We evaluated the ability of columns packed with Selesorb and Liposorber beads, which are both clinically used, to remove BRMs from PLT concentrates (PCs) stored for 5 days. The levels of these BRMs were determined before and after adsorption. RESULTS The adsorption columns significantly reduced the levels of RANTES and sCD40L and partially reduced TGF-β1. There were no significant effects on PLT activation, aggregation, morphology, and plasma lactate dehydrogenase (an indicator of PLT lysis) levels, or hypotonic shock response. Adsorption, however, reduced the PLT recovery to approximately 60% of the untreated value. CONCLUSIONS This study showed that the levels of BRMs were substantially reduced using columns of clinically available adsorption beads. PLT functions and the quality of PCs were maintained after adsorption. The use of adsorption columns may be useful in reducing the incidence of nonhemolytic transfusion reactions.
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Application of the Berlin definition in PROMMTT patients: the impact of resuscitation on the incidence of hypoxemia. J Trauma Acute Care Surg 2013; 75:S61-7. [PMID: 23778513 DOI: 10.1097/ta.0b013e31828fa408] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Acute lung injury following trauma resuscitation remains a concern despite recent advances. With the use of the PROMMTT study population, the risk of hypoxemia and potential modifiable risk factors are studied. METHODS Patients with survival for 24 hours or greater with at least one intensive care unit day were included in the analysis. Hypoxemia was categorized using the Berlin definition for adult respiratory distress syndrome: none (PaO₂-to-FIO₂ ratio [P/F] > 300 mm Hg), mild (P/F, 201-300 mm Hg), moderate (P/F, 101-200 mm Hg) or severe (P/F ≤ 100 mm Hg). The cohort was dichotomized into those with none or mild hypoxemia and those with moderate or severe injury. Early resuscitation was defined as that occurring 0 hour to 6 hours from arrival; late resuscitation was defined as that occurring 7 hours to 24 hours. Multivariate logistic regression models were developed controlling for age, sex, mechanisms of injury, arrival physiology, individual Abbreviated Injury Scale (AIS) scores, blood transfusions, and crystalloid administration. RESULTS Of the patients 58.7% (731 of 1,245) met inclusion criteria. Hypoxemia occurred in 69% (mild, 24%; moderate, 28%; severe, 17%). Mortality was highest (24%) in the severe group. During early resuscitation (0-6 h), logistic regression revealed age (odd ratio [OR], 1.02; 95% confidence interval [CI], 1.00-1.04), chest AIS score (OR, 1.31; 95% CI, 1.10-1.57), and intravenously administered crystalloid fluids given in 500 mL increments (OR, 1.12; 95% CI, 1.01-1.25) as predictive of moderate or severe hypoxemia. During late resuscitation, age (OR, 1.02; 95% CI, 1.00-1.04), chest AIS score (OR, 1.33; 95% CI, 1.11-1.59), and crystalloids given during this period (OR, 1.05; 95% CI, 1.01-1.10) were also predictive of moderate-to-severe hypoxemia. Red blood cell, plasma, and platelet transfusions (whether received during early or late resuscitation) failed to demonstrate an increased risk of developing moderate/severe hypoxemia. CONCLUSION Severe chest injury, increasing age, and crystalloid-based resuscitation, but not blood transfusions, were associated with increased risk of developing moderate-to-severe hypoxemia following injury.
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Hamzeh-Cognasse H, Damien P, Nguyen KA, Arthaud CA, Eyraud MA, Chavarin P, Absi L, Osselaer JC, Pozzetto B, Cognasse F, Garraud O. Immune-reactive soluble OX40 ligand, soluble CD40 ligand, and interleukin-27 are simultaneously oversecreted in platelet components associated with acute transfusion reactions. Transfusion 2013; 54:613-25. [PMID: 23944651 DOI: 10.1111/trf.12378] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 06/10/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Leukoreduction of labile blood components dramatically decreases the frequency of minor, intermediate, and severe adverse events (AEs), referred to as acute transfusion reactions (ATRs), especially after transfusion of platelet components (PCs). The pathophysiology of AEs may result from accumulation of soluble, secreted, platelet (PLT) factors with proinflammatory functions stored in PCs. Thus, several cosynergizing factors associated with PLT accumulation in PCs may contribute to clinically reported ATRs with inflammatory symptoms. STUDY DESIGN AND METHODS We screened for 65 PLT-associated secretory products in PCs that caused ATRs and identified PLT molecules associated with ATRs and inflammation. A functional in vitro study using PC supernatants assayed on reporting immune cells was performed to indicate relevance. RESULTS Among 10,600 apheresis PCs, 30 caused inflammatory ATRs and contained significantly elevated levels of soluble CD40 ligand (sCD40L), interleukin (IL)-27, and soluble OX40 ligand (sOX40L). Normal PLTs secreted IL-27 and sOX40L at bioactive concentrations upon thrombin stimulation and were up regulated in association with ATRs, similar to sCD40L. Other secreted products were identified but not investigated further as their positivity was not consistent. CONCLUSIONS This study demonstrates the putative participation of PLT-derived sOX40L, IL-27, and sCD40L, which accumulate in PC supernatants, with inflammatory-type ATRs. Further studies are required to determine the clinical significance of these findings to forecast preventive measures whenever possible.
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27
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Garraud O, Cognasse F, Hamzeh-Cognasse H, Laradi S, Pozzetto B, Muller JY. Transfusion sanguine et inflammation. Transfus Clin Biol 2013; 20:231-8. [DOI: 10.1016/j.tracli.2013.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Nagura Y, Tsuno NH, Ohkawa R, Nojiri T, Tokuhara Y, Matsuhashi M, Yatomi Y, Takahashi K. Inhibition of lysophosphatidic acid increase by prestorage whole blood leukoreduction in autologous CPDA-1 whole blood. Transfusion 2013; 53:3139-48. [PMID: 23461375 DOI: 10.1111/trf.12152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/08/2013] [Accepted: 01/09/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lysophosphatidylcholine (LPC) has been implicated in the onset of transfusion-related acute lung injury (TRALI). In plasma, LPC is converted to lysophosphatidic acid (LPA) by autotaxin (ATX). The effect of leukoreduction in the accumulation of these bioactive lipids and ATX in human autologous blood has not been fully investigated. STUDY DESIGN AND METHODS The accumulation of choline-containing phospholipids (LPC, sphingomyelin [SM], and phosphatidylcholine [PC]), LPA, and ATX during the storage of autologous blood and the changes caused by leukoreduction were investigated. A total of 26 orthopedic patients were enrolled. Autologous blood was collected as whole blood and, after leukoreduction, preserved refrigerated until use. Prestorage leukoreduced (LR) and non-LR autologous blood samples were analyzed. The time-dependent changes and the effect of the filtration were compared. RESULTS A time-dependent and significant increase in the levels of LPA was observed in both non-LR and LR samples. The concentration of LPA was significantly reduced in LR compared to non-LR samples. The concentration of LPC was higher in LR compared to non-LR samples. The levels of PC, SM, and ATX were not affected by either the storage period or the leukoreduction. CONCLUSIONS Leukoreduction of autologous whole blood effectively reduced the accumulation of LPA. On the other hand, prestorage leukoreduction resulted in an increased concentration of LPC, without significantly affecting ATX. Further studies are necessary to confirm the role of LPA in the pathogenesis of adverse effects of blood transfusion, especially TRALI.
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Affiliation(s)
- Yutaka Nagura
- Department of Transfusion Medicine, University of Tokyo Hospital, Tokyo, Japan; Department of Clinical Laboratory, University of Tokyo Hospital, Tokyo, Japan
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Abstract
Three transfusion complications are responsible for the majority of the morbidity and mortality in hospitalized patients. This article discusses the respiratory complications associated with these pathophysiologic processes, including definitions, diagnosis, mechanism, incidence, risk factors, clinical management, and strategies for prevention. It also explores how different patient populations and different blood components differentially affect the risk of these deadly transfusion complications. Lastly, the article discusses how health care providers can risk stratify individual patients or patient populations to determine whether a given transfusion is more likely to benefit or harm the patient based on the transfusion indication, risk, and expected result.
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Affiliation(s)
- Alexander B Benson
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, 12700 East 19th Avenue, Aurora, CO 80045, USA.
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30
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Massive right-sided colon diverticular bleeding complicated by the transfusion related acute lung injury (TRALI). Open Med (Wars) 2012. [DOI: 10.2478/s11536-012-0079-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractColonic diverticulosis is a condition which causes extensive bleeding of the lower gastrointestine in 40–50% of cases. In particular, right-sided diverticulosis, although uncommon requires lifesaving colectomy. Transfusion related acute lung injury (TRALI) is a transfusion reaction, which can occur after administration of various blood products. Although life threatening, it can be completely reversed usually within 72 to 96 hours. Here, we report a case of a young Caucasian male hospitalized due to severe anemia, hematochezia and extensive blood loss, all due to lower gastrointestinal hemorrhage from right-sided diverticulosis. These conditions were overlooked endoscopically and diagnosed then treated surgically with the right-sided hemicolectomy. During postoperative course, four hours after the last transfusion, patient developed fever, hypoxia and noncardiogenic pulmonary oedema, but made complete recovery through aggressive oxygen support within 96 hours. The aim of this case was to review current literature, to draw attention to a serious and under-diagnosed transfusion reaction, as well as discuss possible explanations for the diagnostic difficulties that occurred in this case.
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Varga C, Al-Touri S, Papadoukakis S, Caplan S, Kahn S, Blostein M. The effectiveness and safety of fixed low-dose prothrombin complex concentrates in patients requiring urgent reversal of warfarin. Transfusion 2012; 53:1451-8; quiz 1450. [PMID: 23067393 DOI: 10.1111/j.1537-2995.2012.03924.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 08/25/2012] [Accepted: 08/26/2012] [Indexed: 01/27/2023]
Abstract
BACKGROUND A rapid method of reversal is required for patients on warfarin who suffer acute bleeding or require emergency surgery. Prothrombin complex concentrates (PCCs) have recently been recommended by the Canadian Blood Services for use at a fixed low dose of 1000 IU of Factor (F)IX activity. The main goal of this study was to investigate both the effectiveness and the safety of fixed low-dose PCCs. STUDY DESIGN AND METHODS We retrospectively reviewed charts from 103 patients who received PCCs for reversal of warfarin therapy. RESULTS A total of 103 patients were treated with PCC at a single fixed dose of 1000 IU of F IX activity. Fifty patients (48.5%) had a final international normalized ratio (INR) response of not more than 1.5 and an additional 45 patients (43.7%) had a final INR response between 1.6 and 2.0. However, 86 patients (83.5%) had an excellent clinical response consisting of control of bleeding without the requirement of additional measures. In a multivariable model, patients who received fresh-frozen plasma and patients who were given doses greater than 1000 IU of PCC were both identified as predictors of a poor clinical response (odds ratio [OR] 3.48, 95% confidence interval [CI] 0.76-15.89, p = 0.11; and OR 10.8, 95% CI 2.08-56.28, 95% CI, p = 0.005, respectively). There were five adverse events up to 30 days after PCC use. CONCLUSION At a fixed dose of 1000 IU of F IX activity, PCC seems to be effective and safe but randomized controlled trials, specifically examining different doses of PCC, are required to confirm the above observations.
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Affiliation(s)
- Cindy Varga
- Departments of Medicine and Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Sharma SK, Kumar S, Singh AK, Seth T, Mishra P, Sharma S, Mahapatra M. Diffuse alveolar hemorrhage following allogeneic peripheral blood stem cell transplantation: a case report and a short review. Indian J Hematol Blood Transfus 2012; 30:41-4. [PMID: 24554821 DOI: 10.1007/s12288-012-0184-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 08/02/2012] [Indexed: 11/26/2022] Open
Abstract
Pulmonary complications are one of the most common causes of morbidity and mortality in patients undergoing peripheral blood stem cell transplantation. Both infective and non-infective etiologies can involve the lungs during this period and differentiating them clinically is a challenging task and management differs in each case. We present here a case of acute myeloid leukemia, in whom following allogeneic peripheral blood stem cell transplantation, diffuse alveolar hemorrhage developed.
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Affiliation(s)
- Sanjeev Kumar Sharma
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Kumar
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Avinash Kumar Singh
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Tulika Seth
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Pravas Mishra
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Sharma
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Manoranjan Mahapatra
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Plasma utilization has increased over the past two decades, and there is a growing concern that many plasma transfusions are inappropriate. Plasma transfusion is not without risk, and certain complications are more likely with plasma than other blood components. Clinical and laboratory investigations of the patients suffering reactions after infusion of fresh-frozen plasma (FFP) define the etiology and pathogenesis of the panoply of adverse effects. We review here the pathogenesis, diagnosis, and management of the risks associated with plasma transfusion. Risks commonly associated with FFP include: 1) transfusion-related acute lung injury, 2) transfusion-associated circulatory overload, and 3) allergic and/or anaphylactic reactions. Other less common risks include 1) transmission of infections, 2) febrile nonhemolytic transfusion reactions, 3) red blood cell alloimmunization, and 4) hemolytic transfusion reactions. The effects of pathogen inactivation or reduction methods on these risks are also discussed. Fortunately, a majority of the adverse effects are not lethal and are adequately treated in clinical practice.
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Affiliation(s)
- Suchitra Pandey
- Department of Laboratory Medicine, University of California, San Francisco, California 94143, USA
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Müller MCA, Juffermans NP. Transfusion-related acute lung injury: a preventable syndrome? Expert Rev Hematol 2012; 5:97-106. [PMID: 22272709 DOI: 10.1586/ehm.11.74] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related morbidity and mortality. Recent insights into the pathophysiology of TRALI have led to various preventive strategies. Strategies in donor management range from antibody testing of sensitized donors to the deferral of female plasma donors altogether. However, knowledge on the efficacy of measures to reduce TRALI is limited. In addition, the various measures may lead to a substantial loss of donors, hampering steady blood supply. Thereby, consensus among countries and blood-collecting facilities regarding the optimal strategy to prevent TRALI is lacking. In this review, the advantages and disadvantages of various preventive measures to prevent TRALI are discussed, related to both patient factors as well as blood component-processing strategies, including transfusion policy, donor management and practices of preparation and storage conditions of blood components.
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Affiliation(s)
- Marcella C A Müller
- Department of Intensive Care & Laboratory of Experimental Intensive Care & Anesthesiology, Academic Medical Center Amsterdam, The Netherlands.
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Vetlesen A, Mirlashari MR, Akkök CA, Kelher MR, Khan SY, Silliman CC, Kjeldsen-Kragh J. Biological response modifiers in photochemically pathogen-reduced versus untreated apheresis platelet concentrates. Transfusion 2012; 53:147-55. [PMID: 22563732 DOI: 10.1111/j.1537-2995.2012.03681.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lipids and other biologically active substances accumulate in platelet concentrates (PCs) during storage. Some of these substances have been suggested to modulate immune responses and to play a pathogenic role in the development of transfusion-related acute lung injury. This study compared the content and impact of some biological response modifiers in PCs treated with pathogen reduction (PR) technology and nontreated PCs. STUDY DESIGN AND METHODS Apheresis PCs (n = 12) were split in two: one split was subjected to PR treatment (INTERCEPT, Cerus Corp.) and the other split was left untreated. Basic characterization and content of vascular endothelial growth factor (VEGF) and sCD154 were measured. Lipopolysaccharide (LPS)-induced secretion of interleukin-10 (IL-10) and tumor necrosis factor-α (TNF-α) was measured after incubation of heparinized whole blood with platelet (PLT) supernatants. The supernatants' neutrophil (PMN)-priming capacity, and thereby activation of the NADPH oxidase, was measured as the rate of superoxide anion production after formyl-Met-Leu-Phe activation. Lipids were extracted from the supernatants on Day 6 and tested for PMN-priming activity. RESULTS Supernatants from PR-treated PCs demonstrated significantly higher mean PLT volume (MPV) and O(2) , lower pH, CO(2) , and HCO(3-) , and significantly less LPS-induced TNF-α secretion compared to untreated PCs. No differences in swirling, PLT count, potassium levels, glucose consumption, lactate production, IL-10, VEGF, sCD154, or PMN-priming activity were found between the groups over time. CONCLUSION INTERCEPT PR treatment caused no substantial differences in PCs, except for minor changes in MPV and metabolic variables. Further studies are needed to explain the differences in the LPS-induced TNF-α secretion.
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Affiliation(s)
- Annette Vetlesen
- Department of Immunology and Transfusion Medicine, Oslo University Hospital, Ullevaal, Oslo, Norway.
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Urner M, Herrmann IK, Buddeberg F, Schuppli C, Roth Z'graggen B, Hasler M, Schanz U, Mehr M, Spahn DR, Beck Schimmer B. Effects of blood products on inflammatory response in endothelial cells in vitro. PLoS One 2012; 7:e33403. [PMID: 22438924 PMCID: PMC3306413 DOI: 10.1371/journal.pone.0033403] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 02/10/2012] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Transfusing blood products may induce inflammatory reactions within the vascular compartment potentially leading to a systemic inflammatory response. Experiments were designed to assess the inflammatory potential of different blood products in an endothelial cell-based in vitro model and to compare baseline levels of potentially activating substances in transfusion products. METHODS The inflammatory response from pre-activated (endotoxin-stimulated) and non-activated endothelial cells as well as neutrophil endothelial transmigration in response to packed red blood cells (PRBC), platelet concentrates (PC) and fresh frozen plasma (FFP) was determined. Baseline inflammatory mediator and lipid concentrations in blood products were evaluated. RESULTS Following incubation with all blood products, an increased inflammatory mediator release from endothelial cells was observed. Platelet concentrates, and to a lesser extent also FFP, caused the most pronounced response, which was accentuated in already pre-stimulated endothelial cells. Inflammatory response of endothelial cells as well as blood product-induced migration of neutrophils through the endothelium was in good agreement with the lipid content of the according blood product. CONCLUSION Within the group of different blood transfusion products both PC and FFP have a high inflammatory potential with regard to activation of endothelial cells. Inflammation upon blood product exposure is strongly accentuated when endothelial cells are pre-injured. High lipid contents in the respective blood products goes along with an accentuated inflammatory reaction from endothelial cells.
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Affiliation(s)
- Martin Urner
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Inge K. Herrmann
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Felix Buddeberg
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Caroline Schuppli
- Institute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Birgit Roth Z'graggen
- Institute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Melanie Hasler
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Urs Schanz
- Clinic of Haematology, University Hospital Zurich, Zurich, Switzerland
| | - Manuela Mehr
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Donat R. Spahn
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Beatrice Beck Schimmer
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Physiology and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
- * E-mail:
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Lysophosphatidylcholines: Bioactive Lipids Generated During Storage of Blood Components. Arch Immunol Ther Exp (Warsz) 2011; 60:55-60. [DOI: 10.1007/s00005-011-0154-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 08/12/2011] [Indexed: 10/14/2022]
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Nyberg F, Ogiwara A, Harbron CG, Kawakami T, Nagasaka K, Takami S, Wada K, Tu HK, Otsuji M, Kyono Y, Dobashi T, Komatsu Y, Kihara M, Akimoto S, Peers IS, South MC, Higenbottam T, Fukuoka M, Nakata K, Ohe Y, Kudoh S, Clausen IG, Nishimura T, Marko-Varga G, Kato H. Proteomic biomarkers for acute interstitial lung disease in gefitinib-treated Japanese lung cancer patients. PLoS One 2011; 6:e22062. [PMID: 21799770 PMCID: PMC3140475 DOI: 10.1371/journal.pone.0022062] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 06/14/2011] [Indexed: 01/15/2023] Open
Abstract
Interstitial lung disease (ILD) events have been reported in Japanese non-small-cell lung cancer (NSCLC) patients receiving EGFR tyrosine kinase inhibitors. We investigated proteomic biomarkers for mechanistic insights and improved prediction of ILD. Blood plasma was collected from 43 gefitinib-treated NSCLC patients developing acute ILD (confirmed by blinded diagnostic review) and 123 randomly selected controls in a nested case-control study within a pharmacoepidemiological cohort study in Japan. We generated ∼7 million tandem mass spectrometry (MS/MS) measurements with extensive quality control and validation, producing one of the largest proteomic lung cancer datasets to date, incorporating rigorous study design, phenotype definition, and evaluation of sample processing. After alignment, scaling, and measurement batch adjustment, we identified 41 peptide peaks representing 29 proteins best predicting ILD. Multivariate peptide, protein, and pathway modeling achieved ILD prediction comparable to previously identified clinical variables; combining the two provided some improvement. The acute phase response pathway was strongly represented (17 of 29 proteins, p = 1.0×10(-25)), suggesting a key role with potential utility as a marker for increased risk of acute ILD events. Validation by Western blotting showed correlation for identified proteins, confirming that robust results can be generated from an MS/MS platform implementing strict quality control.
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Sahler J, Grimshaw K, Spinelli SL, Refaai MA, Phipps RP, Blumberg N. Platelet storage and transfusions: new concerns associated with an old therapy. ACTA ACUST UNITED AC 2011; 8:e9-e14. [PMID: 22662018 DOI: 10.1016/j.ddmec.2011.06.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Platelet transfusion has long been practiced with rudimentary knowledge about optimal storage conditions and their implications for efficacy and, particularly, safety. Recent concerns about complications such as inflammation, thrombosis and altered recipient immunity have been raised about platelet transfusion. This review will discuss recent important findings that have raised these issues about platelet transfusion associated morbidity, mortality and the possible role of platelet storage in these associations.
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Affiliation(s)
- Julie Sahler
- Department of Microbiology and Immunology, University of Rochester
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Weinberg JA, Barnum SR, Patel RP. Red blood cell age and potentiation of transfusion-related pathology in trauma patients. Transfusion 2011; 51:867-73. [PMID: 21496048 DOI: 10.1111/j.1537-2995.2011.03098.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The specific negative clinical manifestations associated with the transfusion of stored red blood cells (RBCs) and the corresponding mechanisms responsible for such phenomena remain poorly defined. Our recent studies document that leukoreduced older RBC units potentiate transfusion-related toxicity in trauma patients. It is our hypothesis that the transfusion of relatively older blood impedes microvascular perfusion. The central mechanisms proposed to mediate this microcirculatory alteration include: 1) the loss of RBC-dependent control of nitric oxide-mediated homeostasis concerning vasodilation and 2) immune cell and complement activation. In this review, we outline the background for our hypothesis and detail our current investigations toward the understanding of this pathophysiology.
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Affiliation(s)
- Jordan A Weinberg
- Department of Surgery, University of Tennessee Health Science Center, 910 Madison Avenue, #224, Memphis, TN 38103, USA.
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McFarland J, Sarode R. ASH 2010 meeting report-Top 10 clinically oriented abstracts in transfusion medicine. Am J Hematol 2011. [DOI: 10.1002/ajh.21983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Benson AB, Burton JR, Austin GL, Biggins SW, Zimmerman MA, Kam I, Mandell S, Silliman CC, Rosen H, Moss M. Differential effects of plasma and red blood cell transfusions on acute lung injury and infection risk following liver transplantation. Liver Transpl 2011; 17:149-58. [PMID: 21280188 PMCID: PMC3399914 DOI: 10.1002/lt.22212] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Patients with chronic liver disease have an increased risk of developing transfusion-related acute lung injury (TRALI) from plasma-containing blood products. Similarly, red blood cell transfusions have been associated with postoperative and nosocomial infections in surgical and critical care populations. Patients undergoing liver transplantation receive large amounts of cellular and plasma-containing blood components, but it is presently unclear which blood components are associated with these postoperative complications. A retrospective cohort study of 525 consecutive liver transplant patients revealed a perioperative TRALI rate of 1.3% (7/525, 95% confidence interval = 0.6%-2.7%), which was associated with increases in the hospital mortality rate [28.6% (2/7) versus 2.9% (15/518), P = 0.02] and the intensive care unit length of stay [2 (1-11 days) versus 0 days (0-2 days), P = 0.03]. Only high-plasma-containing blood products (plasma and platelets) were associated with the development of TRALI. Seventy-four of 525 patients (14.1%) developed a postoperative infection, and this was also associated with increased in-hospital mortality [10.8% (8/74) versus 2.0% (9/451), P < 0.01] and a prolonged length of stay. Multivariate logistic regression determined that the number of transfused red blood cell units (adjusted odds ratio = 1.08, 95% confidence interval = 1.02-1.14, P < 0.01), the presence of perioperative renal dysfunction, and reoperation were significantly associated with postoperative infection. In conclusion, patients undergoing liver transplantation have a high risk of developing postoperative complications from blood transfusion. Plasma-containing blood products were associated with the development of TRALI, whereas red blood cells were associated with the development of postoperative infections in a dose-dependent manner.
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Affiliation(s)
- Alexander B. Benson
- Division of Pulmonary Sciences and Critical Care, University of Colorado, Aurora, CO
| | - James R. Burton
- Division of Gastroenterology and Hepatology, University of Colorado, Aurora, CO
| | - Gregory L. Austin
- Division of Gastroenterology and Hepatology, University of Colorado, Aurora, CO
| | - Scott W. Biggins
- Division of Gastroenterology and Hepatology, University of Colorado, Aurora, CO
| | | | - Igal Kam
- Department of Transplant Surgery, University of Colorado, Aurora, CO
| | - Susan Mandell
- Department of Anesthesia, University of Colorado, Aurora, CO
| | | | - Hugo Rosen
- Division of Gastroenterology and Hepatology, University of Colorado, Aurora, CO
| | - Marc Moss
- Division of Pulmonary Sciences and Critical Care, University of Colorado, Aurora, CO
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Middelburg RA, Van Stein D, Zupanska B, Uhrynowska M, Gajic O, Muñiz-Diaz E, Galvez NN, Silliman CC, Krusius T, Wallis JP, Vandenbroucke JP, Briët E, Van Der Bom JG. Female donors and transfusion-related acute lung injury: A case-referent study from the International TRALI Unisex Research Group. Transfusion 2011; 50:2447-54. [PMID: 20529001 DOI: 10.1111/j.1537-2995.2010.02715.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although quantitative evidence is lacking, it is generally believed that the majority of cases of transfusion-related acute lung injury (TRALI) are caused by female blood donors. We aimed to examine the relation between female donors and the occurrence of TRALI. STUDY DESIGN AND METHODS We performed an international, multicenter case-referent study. TRALI patients who were diagnosed clinically, independent of serology or donor sex, and had received transfusions either only from male donors or only from female donors (unisex cases) were selected. The observed sex distribution among the donors of these TRALI patients was compared to the expected sex distribution, based on the relevant donor populations. RESULTS Eighty-three clinical TRALI cases were included; 67 cases received only red blood cells (RBCs), 13 only plasma-rich products, and three both. Among RBC recipients the relative risk (RR) of TRALI after a transfusion from a female donor was 1.2 (95% confidence interval [CI], 0.69-2.1) and among plasma-rich product recipients the RR was 19 (95% CI, 1.9-191). The p value for the difference between RBCs and plasma was 0.023. CONCLUSION Our data support the notion that plasma from female donors is associated with an increased risk of TRALI, while RBCs from female donors are not.
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Affiliation(s)
- Rutger A Middelburg
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Aung FM, Cano P, Fernandez-Vina M, Lichtiger B. Results of HLA antibody testing using ELISA vs the fluorescent bead method and retrospective review of data for recipients of packed RBCs and platelets from male HLA-immunized donors. Am J Clin Pathol 2011; 135:90-5. [PMID: 21173129 DOI: 10.1309/ajcp98jnyhgcgmhk] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We reviewed HLA antibody testing results using an enzyme-linked immunosorbent assay (ELISA) for all male blood donors at our institution during a 3.5-month period to look for HLA immunization. Confirmatory testing of 33 blood samples positive for HLA class I and/or II antibodies was performed using the fluorescent bead method. A retrospective review of recipients of packed RBCs and platelets processed from these 33 HLA-immunized male donors were conducted to identify transfusion-related acute lung injury and cognate antigens. The agreement rates between the methods for HLA class I and II antibodies were 21% (7/33) and 6% (2/33), respectively. We noted HLA antibodies in the male donors corresponding to cognate antigens in 2 recipients of packed RBCs and in 3 recipients of platelets. Of 8 donors positive for HLA antibodies, 5 did not have a history of blood transfusion. We conclude that ELISA was too sensitive and had a high false-positive rate for the detection of HLA class II antibodies.
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Azoulay E. Pleuropulmonary Changes Induced by Drugs in Patients with Hematologic Diseases. PULMONARY INVOLVEMENT IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES 2011. [PMCID: PMC7123804 DOI: 10.1007/978-3-642-15742-4_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Patients with hematologic diseases who are being treated with therapy drugs, or receive radiation therapy or blood transfusions may develop a host of potentially fatal infectious and noninfectious pulmonary complications [1]. The increased complexity of multimodality and high-dose treatment regimens with the intended benefit of augmented antineoplastic efficacy and prolonged disease-free survival, the use of a panel of novel drugs to treat malignant and nonmalignant hematologic conditions (e.g., azacytidine, bortezomib, cladribine, dasatinib, fludarabine, imatinib, lenalidomide, rituximab, and thalidomide), total body irradiation (TBI) and hematopietic stem cell transplantation (HSCT) have increased the incidence of severe sometimes life-threatening pulmonary complications.
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Affiliation(s)
- Elie Azoulay
- Service de Réanimation Médicale, Hôpital Saint Louis, Avenue Claude Vellefaux 1, Paris, 75010 France
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Segel GB, Halterman MW, Lichtman MA. The paradox of the neutrophil's role in tissue injury. J Leukoc Biol 2010; 89:359-72. [PMID: 21097697 DOI: 10.1189/jlb.0910538] [Citation(s) in RCA: 218] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The neutrophil is an essential component of the innate immune system, and its function is vital to human life. Its production increases in response to virtually all forms of inflammation, and subsequently, it can accumulate in blood and tissue to varying degrees. Although its participation in the inflammatory response is often salutary by nature of its normal interaction with vascular endothelium and its capability to enter tissues and respond to chemotactic gradients and to phagocytize and kill microrganisms, it can contribute to processes that impair vascular integrity and blood flow. The mechanisms that the neutrophil uses to kill microorganisms also have the potential to injure normal tissue under special circumstances. Its paradoxical role in the pathophysiology of disease is particularly, but not exclusively, notable in seven circumstances: 1) diabetic retinopathy, 2) sickle cell disease, 3) TRALI, 4) ARDS, 5) renal microvasculopathy, 6) stroke, and 7) acute coronary artery syndrome. The activated neutrophil's capability to become adhesive to endothelium, to generate highly ROS, and to secrete proteases gives it the potential to induce local vascular and tissue injury. In this review, we summarize the evidence for its role as a mediator of tissue injury in these seven conditions, making it or its products potential therapeutic targets.
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Affiliation(s)
- George B Segel
- Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA.
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Abstract
Transfusion-related acute lung injury (TRALI) remains the deadliest complication of transfusion. Consensus definitions of TRALI have been developed but remain controversial. Recent evidence supports a strong relationship between blood transfusion and the development of acute lung injury in the critically ill and trauma population. Plasma and platelet transfusions have been the most commonly implicated blood products. The 'two hit' model may best explain the immune and nonimmune pathogenesis of TRALI. Current treatment remains largely supportive; effective measures for decreasing the incidence of TRALI include the use of predominantly male plasma and apheresis platelets. Greater understanding of the blood component and patient risk factors for TRALI will hopefully lead to novel treatment and preventive strategies for reducing the risk of this life-threatening syndrome.
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Affiliation(s)
- Mladen Sokolovic
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue C-1179, New York, NY 10065, USA
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50
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Vassallo RR, Hsu S, Einarson M, Barone J, Brodsky J, Moroff G. A comparison of two robotic platforms to screen plateletpheresis donors for HLA antibodies as part of a transfusion-related acute lung injury mitigation strategy. Transfusion 2010; 50:1766-77. [DOI: 10.1111/j.1537-2995.2010.02626.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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