Transfusion-related acute lung injury (TRALI) is a rare but serious syndrome characterized by sudden acute respiratory distress following transfusion. It is defined as new, acute lung injury (ALI) during or within six hours after blood product administration in the absence of temporally-associated risk factors for ALI.
Current recommendations of the NAC indicate that the provision of CMV-seronegative and leukoreduced blood products is potentially required only in the setting of intrauterine transfusion. In October 2017, Canadian Blood Services will stop the testing donor blood for anti-CMV antibodies except for a small inventory of blood components tested for the sole purpose of intrauterine transfusion.
The approach to transfusion in emergent situations varies dramatically depending on the clinical scenario. The primary guiding determinant is the clinician’s assessment of the rapidity of bleeding, the severity of hemorrhage or amount of blood lost, and the clinical stability of the patient. Using the severely injured trauma patient as a case study, this chapter will discuss the principles of massive hemorrhage and resuscitation, with the inclusion of special situations such as obstetrical hemorrhage, where data are available.
Abnormal bleeding may result from defects in platelets, coagulation factors and/or blood vessels. Screening tests for coagulation factor abnormalities include the activated Partial Thromboplastin Time (aPTT) and Prothrombin Time (PT) / International Normalized Ratio (INR). Thrombocytopenia is the most common platelet defect. Qualitative platelet defects may also occur and, in some cases, may be associated with thrombocytopenia. In patients with platelet defects, bleeding time and/or closure times using the platelet function analyzer (PFA-100/200TM) may be prolonged. Vascular defects may be accompanied by joint hyperflexibility or skin laxity. Effective treatment of hemostatic disorders requires accurate diagnosis and special coagulation testing that may include coagulation factor assays, inhibitor assays, and platelet function tests. An algorithmic approach to diagnosis is beyond the scope of this review.
Immune globulin (Ig) products are generated from plasma collected from a large number of carefully screened donors. Ig products may be used as replacement therapy for immunodeficiency patients or as immunomodulatory therapy for autoimmune and alloimmune disorders. Ig products include intravenous Ig (IVIg), subcutaneous Ig (SCIg), RhD Ig (RhIg) and hyperimmune globulins.