Clinical Pathology Selected Abstracts, 11/13

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Clinical pathology abstracts editor: Deborah Sesok-Pizzini, MD, MBA, associate professor, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and medical director, Blood Bank and Transfusion Medicine, Children’s Hospital of Philadelphia.

Analysis of transfusion related lung injury in children

Transfusion-related lung injury continues to be a concern and has become the leading cause of transfusion-related mortality. Recent efforts to store plasma from male donors and newer regulations that require screening for human leukocyte antibody female donors are intended to help mitigate the risk of transfusion-related lung injury (TRALI). The authors submitted a retrospective review of TRALI cases to the Canadian Blood Service to characterize the demographic features, clinical presentation, patient outcomes, and antibody profiles of TRALI patients. The review included 284 TRALI cases, with 17 occurring in children. The authors reviewed reported TRALI cases during a 10-year period. Their results showed no significant difference between pediatric or adult patients with TRALI with regard to presentation or outcome. The majority of the pediatric patients were less than a year old or teenagers. The estimated rate of TRALI using crude modeling per 100,000 red blood cell transfusions was estimated at 5.58 for children and 3.75 for adults. At least half of the cases involved red blood cell components, in contrast to other studies that reported a lower rate of TRALI incidence in red blood cell recipients compared to plasma product recipients. The authors concluded that TRALI continues to be a challenging diagnosis and that future studies are needed to determine if different criteria may be necessary to diagnose TRALI in pediatric patients, particularly in neonates. This is due to neonates being vulnerable to fluid overload, which may confound the diagnosis of TRALI in such patients.

Lieberman L, Petraszko T, Yi Q-L. Transfusion-related lung injury in children: a case series and review of the literature [published online ahead of print June 13, 2013]. Transfusion. doi:10.1111/trf.12249.

Correspondence: Dr. Lani Lieberman at lani.lieberman@utoronto.ca