저장 적혈구 수혈 후에 발생한 수혈 관련 급성 폐손상 1예 -증례 보고-

김호현,이동규,박찬용,주재균,김정철 대한중환자의학회 2013 Acute and Critical Care Vol.28 No.2

Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortalities. Each type of blood product is likely to cause TRALI. Patients with TRALI present with dyspnea/respiratory distress and fever. The symptoms, signs and chest radiological findings in TRALI are similar to transfusion associated circulatory overload. Therefore, it is difficult to distinguish such from circulatory overloads. We report a case of TRALI in a 49- year-old woman after stored packed red blood cell transfusion. The patient developed hypoxemia and pulmonary edema after packed red blood cell transfusion during postoperative period. The patient completely recovered after an oxygen support for 3 days.

HLA 항체가 있는 수혈자에게 신선동결혈장 수혈 후 발생한 수혈관련 급성폐손상 1례

장기설,전대원,김영일,오현우,강민구,이정훈,문인태 대한수혈학회 2015 大韓輸血學會誌 Vol.26 No.3

Development of transfusion-related acute lung injury (TRALI), a non-cardiogenic pulmonary edema, after blood transfusion, is a rare but potentially leading cause of mortality from blood transfusion. We report on a case of TRALI in a 51-year male with acute calculous cholecystitis and liver cirrhosis. As preoperative treatment, he was given ten units of fresh frozen plasma (FFP) for 3 days before the operation. During the transfusion of the 10th unit of FFP, he experienced a sudden onset of hemoptysis, tachypnea, tachycardia, and cyanosis. Bilateral pulmonary infiltration not observed on the chest X-ray at the visit was newly developed. There was no evidence of volume overload but severe hypoxemia. Blood transfusion was stopped and he recovered fully after 8 days of oxygen therapy through a nasal cannula. Although HLA and HNA antibodies were not detected in the donor's blood, HLA antibodies (A2, B57, B58) were detected in the patient's blood. We reported this meaningful case of TRALI that occurred after transfusion of only fresh frozen plasma which did not contain human leukocyte antibody in a patient with HLA antibody. 수혈 관련 급성폐손상(transfusion-related acute lung injury, TRALI)은 수혈 후 발생하는 급성 비심장성 폐부종으로 발생 빈도가 드물며, 사망에이를 수 있는 수혈 부작용이다.1,2,15) 본 증례에서는 간경변 및 급성 담낭염을 진단받은 51세 남자환자가 수술 전처치로 신선동결혈장 10단위를 3 일에 걸쳐 수혈 받던 중 각혈, 빈호흡, 빈맥과 청색증을 갑자기 호소하였고, 흉부단순촬영에서 내원 시 보이지 않던 양측 폐침윤이 새로이 발생하였다. 수액과다의 증거가 없었으며, 심한 저산소증이 확인되었다. 환자는 수혈 중단 및 8일간 비강 캐뉼라를 통한 산소 공급으로 완전히 회복될수 있었다. 헌혈자 혈액에서 HLA 및 HNA에 대한 항체는 검출되지 않았으나, 수혈자 혈액에서A2, B57, B58에 대한 HLA 항체가 검출되었다. 이는 HLA 항체를 가진 수혈자가 백혈구 항체가 함유되지 않은 신선동결혈장만을 단독 수혈받은 후 발생한 TRALI로서 의의가 있는 증례였다.

골수이형성증후군이 있는 임산부에서 발생한 수혈관련 급성폐손상- 증례 보고 -

지영석,성태윤,이석진,유황주,정기순,강포순 대한마취통증의학회 2019 Anesthesia and pain medicine Vol.14 No.1

Transfusion-related acute lung injury (TRALI) is defined as a new episode of acute lung injury that occurs during or within 6 hours of a completed transfusion, which is one of the leading causes of transfusion-related morbidity and mortality. We present a case of TRALI in a 29-year-old parturient with myelodysplastic syndrome scheduled for cesarean section. The parturient developed hypoxemia and dyspnea after preoperative transfusion of platelets following apheresis to eliminate a unit of leucocyte in order to correct thrombocytopenia. She underwent emergent caesarean section for fetal distress. After surgery, the chest radiograph showed diffuse haziness of both lung fields. Direct and indirect antiglobulin tests were negative, and hemolytic transfusion reaction was ruled out. Pro-BNP 347.3 pg/ml also excluded transfusion-associated circulatory overload. The parturient completely recovered after oxygen support for 2 days. It is important to recognize TRALI as soon as possible to minimize perioperative morbidity and mortality.

Two Cases of Transfusion-related Acute Lung Injury Triggered by HLA and Anti-HLA Antibody Reaction

이지현,강은숙,김대원 대한의학회 2010 Journal of Korean medical science Vol.25 No.9

Transfusion-related acute lung injury (TRALI) is a serious adverse transfusion reaction that is presented as acute hypoxemia and non-cardiogenic pulmonary edema, which develops during or within 6 hr of transfusion. Major pathogenesis of TRALI is known to be related with anti-HLA class I, anti-HLA class II, or anti-HNA in donor’s plasma. However, anti-HLA or anti-HNA in recipient against transfused donor’s leukocyte antigens also cause TRALI in minor pathogenesis and which comprises about 10% of TRALI. Published reports of TRALI are relatively rare in Korea. In our cases, both patients presented with dyspnea and hypoxemia during transfusion of packed red blood cells and showed findings of bilateral pulmonary infiltrations at chest radiography. Findings of patients’ anti-HLA antibodies and recipients’ HLA concordance indicate that minor pathogenesis may be not as infrequent as we’d expected before. In addition, second case showed that anti-HLA class II antibodies could be responsible for immunopathogenic mechanisms, alone.

A case of transfusion-related acute lung injury induced by anti-human leukocyte antigen antibodies in acute leukemia

진선미,장문주,허지영,박명희,송은영,오도연 대한혈액학회 2012 Blood Research Vol.47 No.4

Transfusion-related acute lung injury (TRALI) is a noncardiogenic pulmonary edema that occurs during or within 6 hours after transfusion. Risk factors for TRALI, which is relatively common in critically ill patients, include recent surgery, hematologic malignancy, and sepsis. Here, we report a case of TRALI induced by anti-human leukocyte antigen (anti-HLA) class II antibodies (HLA-DR) occurring after transfusion of platelet concentrates in a patient with acute leukemia. Although most patients with TRALI show improvement within 48‒96 hours, our patient’s condition rapidly worsened, and he did not respond to supportive treatment. TRALI is a relatively common and serious adverse transfusion reaction that requires prompt diagnosis and management.

심부전 환자에서 수혈관련급성폐손상의 진단 1예

홍윤지,김정아,최규태,이경훈,박경운,송정한,한규섭 대한수혈학회 2011 大韓輸血學會誌 Vol.22 No.3

A 71-yr old man with known coronary heart disease complained of dyspnea and severe sweating one hour after transfusion of one unit of packed Red Blood Cells (pRBC). Although the heart failure was secondary to the remote acute myocardial infarction, except inflammatory lesion in his toes, he had remained asymptomatic for a long time. Observed as having clear lungs a few hours before transfusion, the patient suffered an acute hypoxic episode (SpO2=61%) and a resulting chest x-ray revealed bilateral pulmonary infiltrates. Confused as the cause of the acute deterioration, he was transferred to the intensive care unit and received managed lung care by mechanical ventilation as well as other conservative care methods. Two days after the acute hypoxic event there was apparent clinical improvement, and he was weaned from ventilator support. His amelioration resulted in subsequent diagnosis of Transfusion-Related Acute Lung Injury (TRALI). TRALI is underdiagnosed in patients due to its nebulous nature. Evaluating patients exhibiting symptoms of bilateral lung infiltrate after blood transfusion for TRALI, and subsequent reporting of the diagnosis results, will help reveal the actual frequency of incidence of TRALI, and prevent additional events by tracing the blood donor.

단일 기관에서의 수혈관련 급성폐손상 증례보고 및 새로운 진단 기준에 대한 고찰

이광섭,김신영,노주혜,최승준,김현옥 대한수혈학회 2019 大韓輸血學會誌 Vol.30 No.3

Background: Transfusion-related acute lung injury (TRALI) is defined as acute respiratory distress syndrome with non-cardiogenic pulmonary edema caused by transfusion. It occurs only rarely but could result in patient mortality. TRALI has been declining since the successful adoption of TRALI risk mitigation strategies in several countries. The new diagnostic criteria were suggested in 2019 based on the knowledge and experience gained throughout the last decade. This article integrated a series of TRALI cases diagnosed in a tertiary hospital while reviewing each case based upon the new diagnostic criteria. Methods: Among the reported transfusion adverse reactions that occurred from March 2013 to June 2019, seven TRALI cases were recruited for this study. Each case was retrospectively reexamined with its clinical condition and transfusion history. The diagnosed cases were classified into TRALI subtypes newly suggested in the 2019 version. Results: The mean time interval to adverse reaction was 117 minutes (range: 7~370 minutes) and all satisfied the condition of hypoxemia and bilateral pulmonary infiltrations. The transfused blood components were apheresis platelets in three cases, platelet concentrates in one case, red blood cells in one case and combinations of different products in two cases. Five cases were diagnosed as possible TRALI, and all five cases were diagnosed as TRALI type 2 (2019 criteria). Conclusion: In our center, seven patients were diagnosed TRALI during the last 6 years. Screening more TRALI patients according to the new criteria, along with investigating the patients’ clinical characteristics, transfused blood components, treatments and integrated research, will facilitate Korean research on this field of medicine. (Korean J Blood Transfus 2019;30:219-229)

Transfusion-Related Acute Lung Injury (TRALI) in Patients with Aneurysmal Subarachnoid Hemorrhage (SAH)

김수훈,Young Bem Se,전형준,김동원,이형중 대한뇌혈관외과학회 2010 Journal of Cerebrovascular and Endovascular Neuros Vol.12 No.1

Objective : Transfusion-related acute lung injury (TRALI) is a poorly understood, but life-threatening complication after transfusion of blood components. The present study was conducted to identify the incidence of TRALI in patients with aneurysmal subarachnoid hemorrhage (SAH) as well as to determine the risk factors for TRALI. Methods:Thisretrospectivestudywascarriedoutonourinstitute, during the period of Jan. 2006 and Dec. 2008 to a total of 237 patients who underwent microsurgical treatment for aneurysmal SAH. In this time period, 154 patients were finally enrolled in this study. Patients’ demographics, clinical and radiographic factors relevant to the aneurysms and SAH, and parameters regarding transfusion were analyzed and compared. Results:Atotalof9patientshadTRALIamonga total of 154 patients. The incidence of TRALI was 0.01% (9 in 836) for all transfused blood component, and 0.06% (9 in 154) for all transfused patients. Statistical analysis showed that Fisher grade III and IV (OR, 1.88; 95% CI, 1.13-3.07) and total amount of transfused units exceeding 1,200cc (OR 1.72; 95% CI, 1.22-2.65) were associated with the development of TRALI. On the other hand, sex, poor Hunt-Hess Grade (IV and V), preoperative hemoglobin less than 13, postoperative hemoglobin less than 11, use of volume expander, premorbid disease (hypertension, diabetes) were not associated with TRALI. Conclusions:TheresultsofpresentstudyindicatethatlargeamountSAH and transfusion of blood components more than 1,200cc are risk factors for the development of TRALI. Prospectively designed study with a larger cohort is mandated to confirm the etiology and risk factors of TRALI in stroke practice. (KorJCerebrovascularSurgery12(1):19-25, 2010)

Convalescent Plasma Therapy in Coronavirus Disease 2019: a Case Report and Suggestions to Overcome Obstacles

Im Jae Hyoung,Nahm Chung Hyun,Baek Ji Hyeon,Kwon Hea Yoon,이진수 대한의학회 2020 Journal of Korean medical science Vol.35 No.26

Coronavirus disease 2019 (COVID-19) is rapidly spreading around the world, causing much morbidity and mortality everywhere. However, effective treatments or vaccines are still not available. Although convalescent plasma (CP) therapy can be useful in the treatment of COVID-19, it has not been widely used in Korea because of the concerns about adverse effects and the difficulty in matching patients to donors. The use of ABO-incompatible plasma is not contraindicated in treatment, but can be hesitated due to the lack of experience of physicians. Here, we describe a 68-year old man with COVID-19 who was treated ABO-incompatible plasma therapy; additionally, we comment on the acute side effects associated with ABO mismatch transfusion. To overcome the obstacles of donor-recipient connections (schedule and distance), we propose the storage of frozen plasma, modification of the current Blood Management Law, and the establishment of a CP bank. We suggest that experience gained in CP therapy will be useful for not only the treatment of COVID-19, but also for coping with new emerging infectious diseases.

한국 임산부에서 Human Neutrophil Alloantigen-3a 동종면역

한태희,한규섭 대한수혈학회 2015 大韓輸血學會誌 Vol.26 No.2

Background: Alloantibodies against human neutrophil alloantigen (HNA)-3a are associated with severe and fatal transfusion related acute lung injury (TRALI). HNA-3 genotyping and HNA-3a antibody (Ab) identification are essential to diagnosis and prevention of TRALI caused by HNA-3a Ab. However there had been no laboratory for HNA-3a Ab identification in Korea. The aims of this study were to establish the HNA-3a Ab test in Korea and to estimate the incidence of HNA-3a alloimmunization among pregnant Korean women. Methods: HNA-3a homozygotes and HNA-3b homozygotes were identified by HNA-3 genotyping. Three HNA-3a homozygotes and three HNA-3b homozygotes are included in the granulocytes panel, which consisted of 10 donors for granulocytes. Sera from 650 pregnant Korean women were tested for granulocyte Ab using a mixed passive hemagglutination assay (MPHA). When a HNA-3a Ab was detected, the woman’s HNA-3 was typed to support her HNA-3a alloimmunization. Results: MPHA showed positive reactions in the sera from 26 women (4.0%, 26/650). HLA Abs were detected in 18 women (2.8%, 18/650), among whom HNA Abs were identified simultaneously in 7 women. Granulocyte Abs were detected in sera from 15 women (2.3%, 15/650). The incidence of HNA-3a, HNA-1b, HNA-1a, HNA-2a, and unidentified HNA Abs among pregnant Korean women was 0.77% (5/650), 0.77% (5/650), 0.62% (4/650), 0.15 (1/650), and 0.31% (2/650), respectively. Conclusion: In this study, we established the HNA-3a Ab test using MPHA for diagnosis and prevention of TRALI caused by HNA-3a Ab. The incidence of HNA-3a Ab in pregnant Korean women was 0.77% (5/650). 배경: HNA-3a 항체는 심각하고 치명적인 수혈관련급성폐손상의 원인이다. HNA-3 유전자검사와 HNA-3a 항체 동정검사는 HNA-3a 항체에 의해 발생하는 수혈관련급성폐손상을 진단하고 예방하는데 필수적인 검사이다. 하지만 한국에는아직 HNA-3a 항체를 동정하는 검사실이 없었다. 저자들은 이번 연구에서 HNA-3a 항체검사를 한국에서도 시행할 수 있게 하고 한국 임산부의HNA-3a 동종면역 발생률을 확인하고자 하였다. 방법: HNA-3a 동형접합자와 HNA-3b 동형접합자를 HNA-3 유전자검사로 확인하였다. 각각 3명의 HNA-3a 동형접합자와 HNA-3b 동형접합자를포함한 10인의 공혈자의 과립구로 제작한 과립구패널이 제조되었다. 혼합수동적혈구응집법(MPHA) 으로 650명의 임산부의 혈청을 이용하여 과립구항체 검사를 실시하였다. HNA-3a 항체가 검출되면 HNA-3a 동종면역을 확인하기 위해 HNA-3 유전자검사를 시행하였다. 결과: 혼합수동적혈구응집법을 이용하여 총26명(4.0%, 26/650)의 임산부의 혈청에서 양성반응을 확인하였다. HLA 항체를 18명(2.8%, 18/650) 의 혈청에서 검출하였다. 이 중 과립구항체와 HLA 항체가 동시에 검출된 경우가 7명이었다. 과립구항체는 15명(2.3%, 15/650)의 임산부의 혈청에서검출되었다. HNA-3a 항체, HNA-1b 항체, HNA-1a 항체, HNA-2a 항체, 특이성이 동정되지 않은 과립구항체가 각각 0.77% (5/650), 0.77% (5/650), 0.62% (4/650), 0.15 (1/650), 0.31% (2/650)로 확인되었다. 결론: 이번 연구에서 저자들은 HNA-3a 항체에의해 발생하는 수혈관련급성폐손상의 진단과 예방에 사용할 수 있는 혼합수동적혈구응집법을 이용한 HNA-3a 항체 검사를 확립하였다. 한국인 임산부에서 HNA-3a 항체발생률은 0.77% (5/650)이었다.