Blood Transfusion And Transfusion Related Acute Lung Injury

The market of human blood transfusions is broken down into different uses: Elective Surgery, Emergency Surgery and Trauma. However, Hemopure seems to be suitable only for trauma cases due to its characteristics and, again, high price. To understand the reason, it is important to notice that, actually, only 10% of the 500,000 trauma victims receives RBCs “in the field” or at the site of accident, and the remaining 95% of these people does not receive transfusions until they arrive at the hospital. This delay was often cited as a major factor to the 20,000 trauma deaths. Therefore, since the expected market share for Biopure is 25% and assuming that the total blood transfusions remain stable, the potential market size for Hemopure is approximately $350,000,000. This size is based on an average price of $700 multiplied by 2,000,000 units (around 4 blood units are needed for each Trauma case).

For the pass this assignment will describe the investigations that are carried out to enable the diagnosis of these physiological disorders. For the merit this assignment will assess possible difficulties involved in the diagnosis from their signs and symptoms.

Proper patient identification in hospitals has been an issue for many years, especially when it comes to blood specimen collection. Laboratory specimens being mislabeled are a everyday cause of harm to patients including repeat diagnostic procedures; repeat phlebotomy; delays in necessary surgical procedures; a performing unnecessary surgical procedures (Dunn and Moga, 2010). This is not only costly, but it is very stressing to patients and medical staff. The biggest concern is the possibility of making a fatal error when it comes to specimen collection. Without proper patient identification this risk increases substantially. Wallin, Sodberg, Van Guelpen, Stenlund, Grankvist, and Brulin (2009) state that critical errors in patient identification for blood testing occurs in up to one per 1000 specimens or procedures and misidentified specimens cause 160,000 adverse events every year in America.

For the purposes of this paper, the author will only focus on National Patient Safety Goals 01.01.01: Identifying patients correctly and 01.03.01 Eliminate transfusion errors related to patient misidentification.

2-Blood transfer: Put a wrong blood type in patient record may cause to transfer a wrong type of blood to the patient which could cause the death in some cases.

According to the American Lung Association, “Acute respiratory distress syndrome (ARDS) is a rapidly progressive disease occurring in critically ill patients.” ARDS is an extreme manifestation of a lung injury that can be associated with an acute medical problem. This occurs as a result of direct or indirect trauma to the lungs. With nearly 200,000 cases in the United States each year, ARDS is not extremely common (“Acute Respiratory Distress Syndrome”). Most people who acquire this disease are critically ill patients within the hospital. The most common predisposing medical problems of ARDS consist of: shock, trauma, pulmonary infections, sepsis, aspiration, and cardiopulmonary bypass (Ignatavicious, 2013). ARDS is a severe syndrome and even with prompt and aggressive medical treatment, almost fifty percent of those diagnosed do not survive. Those who survive have a longer hospital stay along with recurring hospital admissions throughout their lifetime (“Acute Respiratory Distress Syndrome”). Acute respiratory distress syndrome is a rapidly progressive disease which requires thorough assessment, rapid diagnosis, and emergency treatment measures in order to successfully respond to the disease process.

Major patient safety events are rarely a single error event. The events are usually a series of interrelated omissions or system errors. The following errors were noted:

It is a real challenge to differentiate among such complex clinical cases; where there are many similarities present and confuse the clinician while assessing the client. However, clinician’s knowledge and experience can help in reaching the most optimum diagnosis.

Transfusion related acute lung injury (TRALI) has been an upcoming cause of transfusion related mortality. It is characterized by the sudden development of non cardiac related pulmonary edema after transfusion of blood products. According to the Food and Drug Administration (FDA), in the past two reporting years, it has been the leading cause of transfusion related deaths. It is of severe importance for physicians, nurses and also laboratory scientists to become familiar with the presentations of TRALI since many cases will remain unnoticed or will be misdiagnosed as fluid overload, or acute lung injury of other etiology.

Transfusion related lung injury is a form of acute lung injury and is an important cause of transfusion-associated morbidity and mortality. A Transfusion Related Lung Injury (TRALI) is defined as an acute lung injury with hypoxemia and PaO2/FiO2 less than or equal to 300 or SpO2 less than 90 percent on room air, presence of bilateral pulmonary edema with no evidence of left atrial hypertension, no preexisting lung injury before transfusion, onset of symptoms within six hours of transfusion and no temporal relationship to an alternative risk factor for acute lung injury. The transfusion related lung injury is mostly transient and will improve within 48 to 96 hours. Unlike other transfusion related circulatory overload, TRALI is non cardiogenic

Through a medical approach, we have discovered some symptoms that illustrate this fact in the case

Transfusing the blood of choice for platelets, plasma, and RBC in ABO-incompatible transplants is essential to prevent hemolysis and delayed engraftment.

Transfusion-Related Acute Lung Injury (TRALI) is a reaction, generally presenting during or within 1-2 hours of a transfusion. It is the leading cause of transfusion-related mortality based on 2011 FDA data. Symptoms are a sudden onset of respiratory distress and hypoxemia which may be accompanied by fever, tachycardia, tachypnea and sometimes hypotension. Most instances of TRALI are believed to be caused by anti-leukocyte antibodies present in a donor’s plasma. These antibodies are directed against HLA or neutrophil antigens present on the blood recipient’s white blood cells. This reaction is believed to start in the small microvasculature of the lung. This causes a series of events resulting in damage to alveolar capillaries and leakage of fluid leading to pulmonary edema. There is no specific way to prevent TRALI except by minimizing the number of transfusions administered. Since blood component collections centers (ex. Red Cross) have implemented policies to restrict plasma donation by female donors, this reduces the incidence of anti-leukocyte antibodies which can trigger TRALI. Aggressive supportive care is required over several days. This aggressive supportive care most likely includes adequate respiratory and

If a patient experiences fever after or during having a blood transfusion, it could be caused by the blood transfusion itself or the patient has an illness, which is causing the fever. It is not uncommon for a patient undergoing a blood transfusion to experience a fever due to febrile non-hemolytic reaction (FNHTR) caused by the effect of many different pathogens. Patients whose antibodies react with a donor’s white blood cells present febrile non-hemolytic reactions as well. This is not an uncommon medical situation and has been studied for a long time already. Some scientific studies have shown that certain type of thalassemic patients often get a fever when they get a blood transfusion due to their antibodies working against HLA. As the donor’s white blood cells are destroyed, cytokines are released causing inflammation. Other scientific studies have also shown that these cytokines, once they enter the circulatory system, have the potential to cause a fever. Fever and hypotension can also be caused by the bacterial contamination of the unit used to carry out the blood transfusion. In severe lung injuries, respiratory symptoms often mask the presence of a fever, which is very common during these cases.

A transfusion reaction is the body’s systemic response to the administration of blood. Causes for transfusion reactions can include red cell incompatibility; allergic response due to leukocytes, platelets, plasma protein components of transfused blood, or the anticoagulant (potassium or citrate preservatives) used to store the blood, just to name a few. Symptoms, prevention, and treatment will be discussed for the following transfusion reactions: Transfusion Associated Circulatory Overload (TACO), Transfusion-Related Acute Long Injury (TRALI), Hemolytic Transfusion Reactions, Anaphylaxis and Allergic Transfusion Reactions, and Febrile Transfusion Reactions.