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Trali-Taco Upa25112015
Trali-Taco Upa25112015
TRALI, Welcome
TACO
(apakah memang
benar??)
Teguh Triyono
RSUP Dr Sardjito/
Fakultas Kedokteran UGM
TRALI
Transfusion-related
acute lung injury
(TRALI)
Dyspnea
Tachypnea
Hypoxemia
Bilateral pulmonary opacities on chest
radiograph
Edema fluid in the endotracheal tube of
intubated patients (severe TRALI)
Absence of evidence of volume overload or
cardiac dysfunction as the principal
cause of pulmonary edema.
Sayah et al. Crit Care Clin 28 (2012) 363372
Vlaar &Juffermans
www.thelancet.com. Vol382 September14,2013
Pathogenesis: The
two-hit model
The first hit is underlying patient factors,
resulting in adherence of primed neutrophils to
the pulmonary endothelium.
The second hit is caused by mediators in the
blood transfusion that activate the endothelial
cells and pulmonary neutrophils, resulting in
capillary leakage and subsequent pulmonary
oedema.
The second hit can be antibody-mediated or
non-antibody-mediated.
Vlaar &Juffermans
www.thelancet.com. Vol382 September14,2013
Vlaar &Juffermans
www.thelancet.com. Vol382 September14,2013
2 Forms of TRALI
1. Antibody/Immune mediated
2. Non-antibody mediated
16
80% cases Ab
detected
Hassell et al
2010
Vox Sang
72% cases Ab
detected
Anti-HNA-3a
Anti-HLA II
Strength of Ab
Platelets
Lymphocytes
Monocytes
Endothelial cells
20
Makar et al.Transfusion Medicine Reviews, Vol 26, No 4 (October),
2012: pp 305
Vlaar &Juffermans
www.thelancet.com. Vol382 September14,2013
InvestigationofAbmediatedTRALI
Doesthepatienthave
PMNAbs?
Dothedonationshave
PMNAbs?
SCREENforHNA,HLACI&IIAb
Y
a sso c i
ation
ConfirmpatienthascognateAgtodonorAb?
ca t
i
l
p
im
ed
Fung2007ISBTScienceSeries,Silliman2009BloodReviews
TACO
Vlaar &Juffermans
www.thelancet.com. Vol382 September14,2013
MITIGATION OF T R
ALI
PROPOSED MITIGATION
STRATEGIES
Sex based mitigation: prospective
deferral of multiparous (3
pregnan- cies) women donors
Testing for HLA/ HNA antibodies
Blood processing: lekoreduction,
washing, freshblood
Messages
TRALI is a complex clinical syndrome that
appears to require at least two clinical events
for its development.
TRALI is a clinical diagnosis and should be
made on clinical grounds although laboratory
test may be supportive.
Male-predominant plasma transfusion appears
effective to reduce TRALI and further work is
needed to include all cases and not just those
with donor antibodies.
Terima kasih