Adverse Occurrence type:
54 of 86 patients (63%) with a mean age of 67.6 years old undergoing extensive surgery developed respiratory failure (PaO2/FiO2 <300mmHg) after intraoperative apheresis platelet transfusion. Five cases diagnosed as possible TRALI (5.8%) based on permeability pulmonary edema on chest x-rays and timing within 6 hours. Multivariate logistic regression showed presence of anti-granulocyte antibody in the transfused platelets as significant independent predictor of possible TRALI (OR=13.0).
Time to detection:
< 6 hours
Alerting signals, symptoms, evidence of occurrence:
Active surveillance within 6 hours of platelet transfusion. Respiratory failure defined as PaO2/FiO2 <300mmHg. Independent. All enrolled patients had chest xrays evaluated by independent radiologist for the presence of permeability pulmonary edema or hydrostatic pulmonary edema.
Demonstration of imputability or root cause:
Consensus Conference criteria used; all patients had extensive surgery (an ALI factor), hence possible TRALI.
Kanai R, Iijima T, Hashimoto S, et al. Impact of immunoreactive substances contained in apheresis platelet concentrate on postoperative respiratory function in surgical patients receiving platelet transfusion: a prospective cohort study. Transfus Med. 2013 Oct;23(5):344-50