TRALI: Leukopenia

TRALI: a inflammatory (non-hydrostatic) pulmonary edema Characterized by:

• • acute respiratory distress

 

• • hypoxemia

 

• • hypotension

 

• • fever

 

• • widespread pulmonary infiltrates

 

• • The majority of cases occur within minutes

 

Most are within 1-2 hours, but must be <6 hours after blood product transfusions to qualify as TRALI

• • Happens in 1/5000 blood product transfusions

 

• • Leading cause of transfusion-related mortality

 

• • Occurs at all age groups and equally in both sexes

 

• • Increased susceptibility in the critically ill

 

• • All blood components have been associated with TRALI

 

• • Greatest incidence with plasma-rich components such as: plasma, platelets, and whole blood

 

• • Generally thought to occur via a two-hit hypothesis:

 

• • Neutrophil sequestration and priming: endothelial damage, etc. leads to increased adhesion molecules in the vasculature of the lungs, and they are primed by cytokine release

 

• • Neutrophil activation: Sequestered neutrophils are activated by donor anti-leukocyte antibodies or bioactive lipids

 

• • TRALI rarely occurs in neutropenic patients

 

Leukopenia in TRALI

• • Following pulmonary sequestration of neutrophils, there is a transient neutropenia

 

• • Nakagawa M, Toy P: Acute and transient decrease in neutrophil count in transfusion related acute lung injury: Cases in one hospital. Transfusion 2004; 44:1689–1694

 

• • A white blood cell count should be obtained immediately on recognition of the signs and symptoms, because the leukopenia is transient (Ref. 1)

 

• • The amount of leukopenia reported in some case reports is from 8% to 30% of the pre-TRALI WBC (Ref. 2)

 

• • The time of duration, as stated in some case reports, is a gradual increase back to baseline over 6-10 hours. (Ref. 2)

 

• • No other acute transfusion reaction is accompanied by leukopenia