| An association between decreased cardiopulmonary complications (transfusion-related acute lung injury and transfusion-associated circulatory overload) and implementation of universal leukoreduction of blood transfusions. | |
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MedLine Citation:
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PMID: 20561296 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Cardiopulmonary adverse events after transfusion include transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO), which are potentially lethal and incompletely understood. STUDY DESIGN AND METHODS: To determine whether the incidence of TRALI and TACO was affected by leukoreduction we conducted a retrospective, before-and-after study of acute transfusion reactions for the 7years before and after introduction of universal leukoreduction in 2000, involving 778,559 blood components. RESULTS: Substantial decreases occurred in the rates of TRALI (-83%; from 2.8 cases per 100,000 components before to 0.48 after universal leukoreduction; p=0.01), TACO (-49%; 7.4 to 3.8 cases per 100,000; p=0.03), and febrile reactions (-35%; 11.4 to 7.4 cases per 10,000; p<0.0001). The incidence of allergic reactions remained unchanged (7.0 per 100,000 before and after universal leukoreduction). These outcomes were primarily attributable to decreased TRALI and/or TACO associated with red blood cell (RBC) and platelet (PLT) transfusions (-64%) with notably smaller decreases associated with fresh-frozen plasma or cryoprecipitate transfusions (-29%). The incidence of TRALI and/or TACO after 28,120 washed RBC and 69,325 washed transfusions was zero. CONCLUSION: These data suggest novel hypotheses for further testing in animal models, in prospective clinical trials, and via the new US hemovigilance system: 1) Is TACO or TRALI mitigated by leukoreduction? 2) Is the mechanism of TACO more complex than excessive blood volume? and 3) Does washing mitigate TRALI and TACO due to PLT and RBC transfusions? |
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Authors:
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Neil Blumberg; Joanna M Heal; Kelly F Gettings; Richard P Phipps; Debra Masel; Majed A Refaai; Scott A Kirkley; L Benjamin Fialkow |
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Publication Detail:
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Type: Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Transfusion Volume: 50 ISSN: 1537-2995 ISO Abbreviation: Transfusion Publication Date: 2010 Dec |
Date Detail:
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Created Date: 2010-12-03 Completed Date: 2011-01-20 Revised Date: 2011-12-21 |
Medline Journal Info:
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Nlm Unique ID: 0417360 Medline TA: Transfusion Country: United States |
Other Details:
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Languages: eng Pagination: 2738-44 Citation Subset: IM |
Copyright Information:
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© 2010 American Association of Blood Banks. |
Affiliation:
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Transfusion Medicine Unit, and the Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York 14642, USA. neil_blumberg@urmc.rochester.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Lung Injury
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epidemiology*,
etiology* Blood Transfusion / adverse effects*, statistics & numerical data* Health Plan Implementation Humans Incidence Leukapheresis / methods, statistics & numerical data* Platelet Transfusion / adverse effects, statistics & numerical data Postoperative Complications / epidemiology, etiology Pulmonary Circulation / physiology Retrospective Studies Time Factors Vascular Diseases / epidemiology*, etiology* |
| Grant Support | |
ID/Acronym/Agency:
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ES01247/ES/NIEHS NIH HHS; HL078603/HL/NHLBI NIH HHS; HL095467/HL/NHLBI NIH HHS; HL100051/HL/NHLBI NIH HHS; P30 ES001247-250109/ES/NIEHS NIH HHS; R01 HL078603-04/HL/NHLBI NIH HHS; R01 HL095467-01A1/HL/NHLBI NIH HHS; RC1 HL100051-01/HL/NHLBI NIH HHS |
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