Article

The mystery of transfusion-related acute lung injury

Transfusion (Impact Factor: 3.57). 10/2011; 51(10):2054-7. DOI: 10.1111/j.1537-2995.2011.03275.x
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Available from: Neil Blumberg, Dec 16, 2013
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    ABSTRACT: Objective To evaluate the effect of premedication on transfusion reactions (TRs) within 24 hours after blood product transfusions in dogs.DesignRetrospective study between 2008 and 2011.SettingPrivate veterinary referral hospital.AnimalsNine hundred and thirty-five transfusion events in 558 dogs.InterventionsNone.Measurements and Main ResultsMedical records of dogs receiving blood product transfusions were reviewed. Information collected included signalment, weight, transfusion product type, reason for transfusion, first or subsequent transfusion, whether an acute reaction occurred, type of reaction, whether the reaction was treated, premedication prior to the transfusion and the premedication used, other medications the animal was given, whether the animal had an immune-mediated process, and whether the transfusion was administered in the perioperative period. A total of 144 (15%) acute TRs were documented in 136 dogs. The most common TRs were fever alone (77/144 [53%]) and vomiting alone (26/144 [18%]). Six dogs died due to the TR (4%). TR was not associated with age (P = 0.257), sex (P = 0.754), weight (P = 0.829), or premedication (P = 0.312). The type of blood product transfused (P < 0.001) was significantly associated with TRs, with packed RBCs most likely associated with a TR, and plasma least likely. Immune disease (P = 0.015) was significantly associated with occurrence of a TR. Significantly fewer reactions were documented following transfusions given in the perioperative period (P = 0.023).Conclusions While most TRs were mild, there were some serious reactions observed including hemolysis, dyspnea, and 6 deaths. Immune-mediated disease was associated with development of a TR, while transfusion during the perioperative period was associated with lower likelihood of reaction. Packed RBC transfusions were associated with development of acute TRs. Overall occurrence of TR was not significantly altered with premedication; however, when evaluated alone, antihistamines decreased the incidence of acute allergic reactions.
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