Article Text

  1. R. Rana,
  2. O. Gajic
  1. Mayo Clinic, Rochester, 1University of Louisville
  2. 2Louisville VAMC


Purpose Transfusion related acute lung injury (TRALI) and transfusion associated circulatory overload (TACO) are important causes of morbidity and mortality following blood transfusions. To describe the 5 year incidence, predictors and outcomes of respiratory failure within 6 hours of blood product transfusion in patients hospitalized at the Mayo Clinic Hospitals, Rochester.

Methods We electronically reviewed the institutional transfusion database and respiratory information system which accurately chart the time and type of blood product transfusion and onset of invasive and noninvasive mechanical ventilation from January 1999 to July 2004. Respiratory failure was defined as the onset of continuous positive airway pressure (CPAP), bi-level positive airway pressure (BiPAP) ventilation or invasive mechanical ventilation within 6 hours of transfusion. We collected data on type of blood products, and in the subgroup of critically ill patients, data relating to demographics, APACHE III scores, predicted hospital mortality.

Results A total of 2,83,313 units were transfused in the 5 year period. 1 in every 400 units transfused was associated with respiratory failure within 6 hours. The implicated products were as follows: 11 in 1000 fresh frozen plasma units, 17 in 1000 cryoprecipitate units, 6 in 1000 of red blood cell units and 5 in 1000 platelet units. 39,446 patients were transfused in 5 years of whom 710 had onset of respiratory failure within 6 hours. Amongst the subgroup of critically ill patients, there was no difference in gender and APACHE III scores of patients with and without the outcome of interest. Patients with transfusion associated respiratory failure were younger (mean age 62 vs. 66 years). When adjusted for predicted hospital mortality in multivariate analysis, transfusion associated respiratory failure was associated with increased risk of hospital mortality (OR 2.2, CI 1.75 to 2.77).

Conclusion The incidence of respiratory failure was highest after transfusion of fresh frozen plasma and cryoprecipitate. Transfusion associated respiratory failure is independently associated with increased mortality in critically ill patients.

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