You,an ER intern transfuse a 60yr โ with 2 units of blood๐ฉธ
5 hrs pass & youre about to leave for home,& she becomes severely breathless๐ฅต
O2 satsใฝ๏ธ80%
O/E ๐Loud rales
You shift her to the ICU and are lost in thought-what just happened?
๐ง๐ฅ๐๐๐ v ๐ง๐๐๐ข -A short thread๐งต
5 hrs pass & youre about to leave for home,& she becomes severely breathless๐ฅต
O2 satsใฝ๏ธ80%
O/E ๐Loud rales
You shift her to the ICU and are lost in thought-what just happened?
๐ง๐ฅ๐๐๐ v ๐ง๐๐๐ข -A short thread๐งต
๐ง๐ฅ๐๐๐: Transfusion-Related Acute Lung Injury and
๐ง๐๐๐ข: Transfusion-Associated Circulatory Overload are important transfusion complications.
๐ง๐ฅ๐๐๐ :~ 1.8 in every lakh transfusions,within 6 hrs of transfusion
๐ง๐๐๐ข :~1% of transfusions, can occur upto 12 hrs
๐ง๐๐๐ข: Transfusion-Associated Circulatory Overload are important transfusion complications.
๐ง๐ฅ๐๐๐ :~ 1.8 in every lakh transfusions,within 6 hrs of transfusion
๐ง๐๐๐ข :~1% of transfusions, can occur upto 12 hrs
TRALI - has 2 pathophysiologic mechanisms:
1.๐๐ป๐๐ถ๐ฏ๐ผ๐ฑ๐ hypothesis-
HLA or HNA(neutrophil) a.b. in the transfused component reacts with neutrophil antigens in the recipient->Recipient neutrophils lodge in pulmonary capillaries-> release mediators--> pulmo capillary leak
1.๐๐ป๐๐ถ๐ฏ๐ผ๐ฑ๐ hypothesis-
HLA or HNA(neutrophil) a.b. in the transfused component reacts with neutrophil antigens in the recipient->Recipient neutrophils lodge in pulmonary capillaries-> release mediators--> pulmo capillary leak
2.๐ก๐ฒ๐๐๐ฟ๐ผ๐ฝ๐ต๐ถ๐น priming hypothesis: Conditions such as infection,surgery,inflammation ->Predisposition to neutrophil priming & endothelial activation-> Bioactive substances in the transfused component activate the primed sequestered neutrophils-->pulmo endothelial damage
๐ง๐๐๐ข pathophysiology-
Volume Overload of the transfused blood components and that of any coincidental infusions --> acute ๐ต๐๐ฝ๐ฒ๐ฟ๐๐ผ๐น๐ฒ๐บ๐ถ๐ฎ --> acute pulmonary edema
Volume Overload of the transfused blood components and that of any coincidental infusions --> acute ๐ต๐๐ฝ๐ฒ๐ฟ๐๐ผ๐น๐ฒ๐บ๐ถ๐ฎ --> acute pulmonary edema
๐๐น๐ถ๐ป๐ถ๐ฐ๐ฎ๐น๐น๐:
๐ง๐ฅ๐๐๐- Essentially a state of ๐๐ฅ๐๐ฆ ๐ซ
๐ง๐๐๐ข- Essentially a state of ๐ต๐ถ๐ด๐ต-๐ผ๐๐๐ฝ๐๐ ๐ฐ๐ฎ๐ฟ๐ฑ๐ถ๐ฎ๐ฐ ๐ณ๐ฎ๐ถ๐น๐๐ฟ๐ฒ ๐
๐ง๐ฅ๐๐๐- Essentially a state of ๐๐ฅ๐๐ฆ ๐ซ
๐ง๐๐๐ข- Essentially a state of ๐ต๐ถ๐ด๐ต-๐ผ๐๐๐ฝ๐๐ ๐ฐ๐ฎ๐ฟ๐ฑ๐ถ๐ฎ๐ฐ ๐ณ๐ฎ๐ถ๐น๐๐ฟ๐ฒ ๐
๐ฅ๐ฎ๐ฑ๐ถ๐ผ๐น๐ผ๐ด๐:
๐ง๐ฅ๐๐๐-
Features of pulmonary oedema(can progress to alveolar & interstitial infiltrates).Lung opacities usually clear within 96 hours in 80% of patients.
๐ง๐๐๐ข-
Features of Pulmonary edema(with/without pleural effusion) + ๐๐ฎ๐ฟ๐ฑ๐ถ๐ผ๐บ๐ฒ๐ด๐ฎ๐น๐
๐ง๐ฅ๐๐๐-
Features of pulmonary oedema(can progress to alveolar & interstitial infiltrates).Lung opacities usually clear within 96 hours in 80% of patients.
๐ง๐๐๐ข-
Features of Pulmonary edema(with/without pleural effusion) + ๐๐ฎ๐ฟ๐ฑ๐ถ๐ผ๐บ๐ฒ๐ด๐ฎ๐น๐
๐ง๐ฟ๐ฒ๐ฎ๐๐บ๐ฒ๐ป๐
Stop transfusion ๐, aggressive respiratory support ๐จ
๐ง๐ฅ๐๐๐ -->Give fluids(if needed) for BP control ๐ง
๐ง๐๐๐ข --> Give Diuretics to remove excess fluid ๐
Stop transfusion ๐, aggressive respiratory support ๐จ
๐ง๐ฅ๐๐๐ -->Give fluids(if needed) for BP control ๐ง
๐ง๐๐๐ข --> Give Diuretics to remove excess fluid ๐
Conceptual trivia!
You deserve some if you've read thus far! ๐
The incidence of ๐ง๐ฅ๐๐๐ can be reduced with increased ๐ฑ๐ผ๐ป๐ผ๐ฟ screening.
The incidence of ๐ง๐๐๐ข can be reduced with increased ๐ฟ๐ฒ๐ฐ๐ถ๐ฝ๐ถ๐ฒ๐ป๐ screening.
#Dailymed
You deserve some if you've read thus far! ๐
The incidence of ๐ง๐ฅ๐๐๐ can be reduced with increased ๐ฑ๐ผ๐ป๐ผ๐ฟ screening.
The incidence of ๐ง๐๐๐ข can be reduced with increased ๐ฟ๐ฒ๐ฐ๐ถ๐ฝ๐ถ๐ฒ๐ป๐ screening.
#Dailymed
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