Resuscitation
Volume 66, Issue 2 , Pages 225-230, August 2005

Report of a patient with severe transfusion-related acute lung injury after multiple transfusions, resuscitated with albumin☆☆☆

  • Alimorad G. Djalali

      Affiliations

    • Department of Anesthesiology, Perioperative Pain Medicine and Intensive Care, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
    • Corresponding Author InformationCorresponding author.
    • ,
  • Kimberly A. Moore

      Affiliations

    • Department of Surgery, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
    • ,
  • Edward Kelly

      Affiliations

    • Division of General and Gastrointestinal Surgery, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA

Received 5 December 2004; received in revised form 1 February 2005; accepted 1 February 2005.

Abstract 

Objective:

To report a patient with a large gastrointestinal stromal tumor (GIST) who received multiple blood transfusions intraoperatively and developed a transfusion-related acute lung injury (TRALI).

Design:

Case report.

Setting:

Intensive care unit of a tertiary care hospital.

Patient and history:

A 58-year-old man with GIST metastatic to the right lobe of the liver, treated with tyrosine kinase inhibitors, underwent a right hepatectomy requiring multiple transfusions. Prior to abdominal closure, he developed copious pulmonary secretions, hypoxemia, and hypotension. Chest radiograph revealed diffuse bilateral infiltrates.

Intervention:

Volume resuscitation, vasopressors, high PEEP mechanical ventilation, paralysis, nitric oxide, steroids, rapid albumin infusion.

Measurements and main results:

Extensive noncardiogenic pulmonary edema. After unsuccessful fluid resuscitation with crystalloid fluid, the patient's condition improved rapidly with human albumin boluses. No neurological deficit was detected despite prolonged hypoxemia. Acute renal failure required dialysis but with subsequent recovery. Patient was discharged home on postoperative day 19.

Conclusion:

Rapid infusion of albumin might be a rescue option in cases of severe TRALI with extensive pulmonary capillary leak during the acute phase.

Keywords: Lung, Noncardiogenic pulmonary edema, Blood, Albumin, Fluid resuscitation, Capillary leak, Acute respiratory failure, Transfusion reaction

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☆ A Spanish translated version of the Abstract and Keywords of this article appears as Appendix at 10.1016/j.resuscitation.2005.02.004.

☆☆ The patient in the case report was treated at Brigham and Women's Hospital.

PII: S0300-9572(05)00121-8

doi:10.1016/j.resuscitation.2005.02.004

Resuscitation
Volume 66, Issue 2 , Pages 225-230, August 2005

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