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Article: Update on transfusion-related acute lung injury.

Toy, Pearl

Clinical advances in hematology & oncology : H&O

2019 Volume 17, Issue 7, Page(s) 378–381

MeSH term(s)	Humans ; Transfusion-Related Acute Lung Injury/diagnosis ; Transfusion-Related Acute Lung Injury/epidemiology ; Transfusion-Related Acute Lung Injury/pathology ; Transfusion-Related Acute Lung Injury/therapy
Language	English
Publishing date	2019-08-26
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2271951-9
ISSN	1543-0790
ISSN	1543-0790
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Article ; Online: Antibodies associated with TRALI: differences in clinical relevance.

Kopko, Patricia M / Bux, Jürgen / Toy, Pearl

Transfusion

2018 Volume 59, Issue 3, Page(s) 1147–1151

MeSH term(s)	Antibodies/immunology ; Blood Donors ; Female ; Humans ; Male ; Transfusion Reaction/immunology ; Transfusion-Related Acute Lung Injury/immunology
Chemical Substances	Antibodies
Language	English
Publishing date	2018-12-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	208417-x
ISSN	1537-2995 ; 0041-1132
ISSN (online)	1537-2995
ISSN	0041-1132
DOI	10.1111/trf.15094
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Article ; Online: Transfusion-related Acute Lung Injury: 36 Years of Progress (1985-2021).

Toy, Pearl / Looney, Mark R / Popovsky, Mark / Palfi, Miodrag / Berlin, Gösta / Chapman, Catherine E / Bolton-Maggs, Paula / Matthay, Michael A

Annals of the American Thoracic Society

2022 Volume 19, Issue 5, Page(s) 705–712

Abstract: The term transfusion-related acute lung injury (TRALI) was coined in 1985 to describe acute respiratory distress syndrome (ARDS) after transfusion, when another ARDS risk factor was absent; TRALI cases were mostly associated with donor leukocyte antibody. ...

Abstract	The term transfusion-related acute lung injury (TRALI) was coined in 1985 to describe acute respiratory distress syndrome (ARDS) after transfusion, when another ARDS risk factor was absent; TRALI cases were mostly associated with donor leukocyte antibody. In 2001, plasma from multiparous donors was implicated in TRALI in a randomized controlled trial in Sweden. In 2003 and in many years thereafter, the U.S. Food and Drug Administration reported that TRALI was the leading cause of death from transfusion in the United States. In 2003, the United Kingdom was the first among many countries to successfully reduce TRALI using male-predominant plasma. These successes are to be celebrated. Nevertheless, questions remain about the mechanisms of non-antibody TRALI, the role of blood products in the development of ARDS in patients receiving massive transfusion, the causes of unusual TRALI cases, and how to reduce inaccurate diagnoses of TRALI in clinical practice. Regarding the latter, a study in 2013-2015 at 169 U.S. hospitals found that many TRALI diagnoses did not meet clinical definitions. In 2019, a consensus panel established a more precise terminology for clinical diagnosis: TRALI type I and TRALI type II are cases where transfusion is the likely cause, and ARDS are cases where transfusion is not the likely cause. For accurate diagnosis using these clinical definitions, critical care or pulmonary expertise is needed to distinguish between permeability versus hydrostatic pulmonary edema, to determine whether an ARDS risk factor is present, and, if so, to determine whether respiratory function was stable within the 12 hours before transfusion.
MeSH term(s)	Blood Transfusion ; Humans ; Male ; Pulmonary Edema/etiology ; Respiratory Distress Syndrome/etiology ; Respiratory Distress Syndrome/therapy ; Transfusion Reaction/complications ; Transfusion-Related Acute Lung Injury/complications ; Transfusion-Related Acute Lung Injury/diagnosis
Language	English
Publishing date	2022-01-19
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	2717461-X
ISSN	2325-6621 ; 1943-5665 ; 2325-6621
ISSN (online)	2325-6621 ; 1943-5665
ISSN	2325-6621
DOI	10.1513/AnnalsATS.202108-963CME
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Article ; Online: Proposed revised nomenclature for transfusion-related acute lung injury.

Toy, Pearl / Kleinman, Steven H / Looney, Mark R

Transfusion

2017 Volume 57, Issue 3, Page(s) 709–713

Abstract: A decade ago, definitions of "transfusionߚrelated acute lung injury (TRALI)" and "possible TRALI" were standardized for research and clinical diagnosis. Since then, evidence has confirmed that TRALI is often due to transfusion of white blood cell ... ...

Abstract	A decade ago, definitions of "transfusionߚrelated acute lung injury (TRALI)" and "possible TRALI" were standardized for research and clinical diagnosis. Since then, evidence has confirmed that TRALI is often due to transfusion of white blood cell antibodies to at-risk patients, and the term "TRALI, antibody mediated" is appropriate for such cases. Other TRALI cases are non-antibody mediated. Because specific, nonantibody transfusion factors have not yet been confirmed to cause TRALI in humans, the general term "TRALI, non-antibody mediated" is appropriate for such cases. In contrast, evidence is against possible TRALI being due to transfusion with the more likely cause of the acute respiratory distress syndrome (ARDS) being the alternative ARDS risk factor present in these patients. We propose to drop the misleading term "possible TRALI" and to rename this category of cases as "transfused ARDS." These nomenclature updates will more accurately categorize ARDS cases that develop after transfusion.
MeSH term(s)	Acute Lung Injury/blood ; Acute Lung Injury/classification ; Humans ; Respiratory Distress Syndrome, Adult/blood ; Respiratory Distress Syndrome, Adult/classification ; Risk Factors ; Transfusion Reaction/blood ; Transfusion Reaction/classification
Language	English
Publishing date	2017-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	208417-x
ISSN	1537-2995 ; 0041-1132
ISSN (online)	1537-2995
ISSN	0041-1132
DOI	10.1111/trf.13944
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Article ; Online: Reply to concerns regarding dropping the term "possible TRALI".

Toy, Pearl / Kleinman, Steven H / Looney, Mark R

Transfusion

2016 Volume 56, Issue 9, Page(s) 2394–2395

Language	English
Publishing date	2016-09
Publishing country	United States
Document type	Letter
ZDB-ID	208417-x
ISSN	1537-2995 ; 0041-1132
ISSN (online)	1537-2995
ISSN	0041-1132
DOI	10.1111/trf.13734
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Article ; Online: Transfusion reactions: newer concepts on the pathophysiology, incidence, treatment, and prevention of transfusion-related acute lung injury.

Sayah, David M / Looney, Mark R / Toy, Pearl

Critical care clinics

2012 Volume 28, Issue 3, Page(s) 363–72, v

Abstract: Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality. TRALI presents as acute lung injury (ALI) within 6 hours after blood product transfusion. Diagnosing TRALI requires a high index of suspicion, and the ... ...

Abstract	Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality. TRALI presents as acute lung injury (ALI) within 6 hours after blood product transfusion. Diagnosing TRALI requires a high index of suspicion, and the exclusion of circulatory overload or other causes of ALI. The pathophysiology of TRALI is incompletely understood, but in part involves transfusion of certain anti-neutrophil antibodies, anti-HLA antibodies, or other bioactive substances, into susceptible recipients. Recent studies have identified both recipient and transfusion risk factors for the development of TRALI. This article describes these TRALI risk factors, as well as diagnosis, treatment and prevention strategies.
MeSH term(s)	Acute Lung Injury/epidemiology ; Acute Lung Injury/etiology ; Acute Lung Injury/physiopathology ; Acute Lung Injury/prevention & control ; Acute Lung Injury/therapy ; Blood Group Incompatibility ; Humans ; Incidence ; Risk Factors ; Transfusion Reaction
Language	English
Publishing date	2012-06-19
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	1006423-0
ISSN	1557-8232 ; 0749-0704
ISSN (online)	1557-8232
ISSN	0749-0704
DOI	10.1016/j.ccc.2012.04.001
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Article: TRALI--definition, mechanisms, incidence and clinical relevance.

Toy, Pearl / Lowell, Clifford

Best practice & research. Clinical anaesthesiology

2007 Volume 21, Issue 2, Page(s) 183–193

Abstract: Transfusion-related acute lung injury (TRALI) is defined as new acute lung injury (ALI) that occurs during or within six hours of transfusion, not explained by another ALl risk factor. Transfusion of part of one unit of any blood product can cause TRALI. ...

Abstract	Transfusion-related acute lung injury (TRALI) is defined as new acute lung injury (ALI) that occurs during or within six hours of transfusion, not explained by another ALl risk factor. Transfusion of part of one unit of any blood product can cause TRALI. The mechanism may include factors in unit(s) of blood, such as antibody and biologic response modifiers. In addition, yet to be described factors in a patient's illness may predispose to the condition. The current incidence is estimated to be 1 in 5000 units. Patients present with acute dyspnea, or froth in the endotracheal tube in intubated patients. Hypertension, hypotension, acute leukopenia have been described. Management is similar to that for ALI and is predominantly supportive. When TRALI is suspected, Blood banks should be notified to quarantine other components from the same donation. No special blood product is required for subsequent transfusion of a patient who has developed TRALI.
MeSH term(s)	Blood Donors ; Genetic Predisposition to Disease ; Humans ; Incidence ; Practice Guidelines as Topic ; Pulmonary Edema/epidemiology ; Pulmonary Edema/etiology ; Respiratory Distress Syndrome, Adult/epidemiology ; Respiratory Distress Syndrome, Adult/etiology ; Risk Assessment ; Risk Factors ; Transfusion Reaction
Language	English
Publishing date	2007-07-03
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1499424-0
ISSN	1521-6896
ISSN	1521-6896
DOI	10.1016/j.bpa.2007.01.003
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Article ; Online: A Clinical Trial to Detect Subclinical Transfusion-induced Lung Injury during Surgery.

Feiner, John R / Gropper, Michael A / Toy, Pearl / Lieberman, Jeremy / Twiford, Jenifer / Weiskopf, Richard B

Anesthesiology

2015 Volume 123, Issue 1, Page(s) 126–135

Abstract: Background: Transfusion-related acute lung injury incidence remains the leading cause of posttransfusion mortality. The etiology may be related to leukocyte antibodies or biologically active compounds in transfused plasma, injuring susceptible recipient' ...

Abstract	Background: Transfusion-related acute lung injury incidence remains the leading cause of posttransfusion mortality. The etiology may be related to leukocyte antibodies or biologically active compounds in transfused plasma, injuring susceptible recipient's lungs. The authors have hypothesized that transfusion could have less severe effects that are not always appreciated clinically and have shown subtly decreased pulmonary oxygen gas transfer in healthy volunteers after transfusion of fresh and 21-day stored erythrocytes. In this study, the authors tested the same hypothesis in surgical patients. Methods: Ninety-one patients undergoing elective major spine surgery with anticipated need for erythrocyte transfusion were randomly allocated to receive their first transfusion of erythrocytes as cell salvage (CS), washed stored, or unwashed stored. Clinicians were not blinded to group assignment. Pulmonary gas transfer and mechanics were measured 5 min before and 30 min after erythrocyte transfusion. Results: The primary outcome variable, gas transfer, as assessed by change of PaO2/FIO2, with erythrocyte transfusion was not significant in any group (mean ± SD; CS: 9 ± 59; washed: 10 ± 26; and unwashed: 15 ± 1) and did not differ among groups (P = 0.92). Pulmonary dead space (VD/VT) decreased with CS transfusion (-0.01 ± 0.04; P = 0.034) but did not change with other erythrocytes; the change from before to after erythrocyte transfusion did not differ among groups (-0.01 to +0.01; P = 0.28). Conclusions: The authors did not find impaired gas exchange as assessed by PaO2/FIO2 with transfused erythrocytes that did or did not contain nonautologous plasma. This clinical trial did not support the hypothesis of erythrocyte transfusion-induced gas exchange deficit that had been found in healthy volunteers.
MeSH term(s)	Acute Lung Injury/diagnosis ; Acute Lung Injury/etiology ; Adolescent ; Adult ; Aged ; Elective Surgical Procedures/adverse effects ; Elective Surgical Procedures/trends ; Erythrocyte Transfusion/adverse effects ; Erythrocyte Transfusion/trends ; Female ; Humans ; Intraoperative Complications/diagnosis ; Intraoperative Complications/etiology ; Male ; Middle Aged ; Pulmonary Gas Exchange/physiology ; Young Adult
Keywords	covid19
Language	English
Publishing date	2015-07
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural
ZDB-ID	269-0
ISSN	1528-1175 ; 0003-3022
ISSN (online)	1528-1175
ISSN	0003-3022
DOI	10.1097/ALN.0000000000000689
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Article ; Online: Transfusion-related acute lung injury after transfusion of maternal blood: a case-control study.

Dunbar, Nancy / Cooke, Margaret / Diab, Mohammad / Toy, Pearl

Spine

2010 Volume 35, Issue 23, Page(s) E1322–7

Abstract: Study design: This is a single-center retrospective case-control study of 7 transfusion-related acute lung injury (TRALI) cases and 28 controls in the pediatric spinal surgery population.: Objective: To determine the association between maternal ... ...

Abstract	Study design: This is a single-center retrospective case-control study of 7 transfusion-related acute lung injury (TRALI) cases and 28 controls in the pediatric spinal surgery population. Objective: To determine the association between maternal transfusion and risk of TRALI in pediatric spinal surgery patients. Summary of background data: Previous studies support a "2-hit" model for the pathogenesis of TRALI-activation and sequestration of neutrophils in the pulmonary vasculature followed by transfusion of a biologic response modifier such as antileukocyte antibodies. Maternal donation of blood products is a potential risk factor for TRALI because of the development of antileukocyte antibodies during pregnancy. Until now there have been no studies specifically addressing the risk of TRALI following maternal transfusions. Methods: This is a retrospective case-control study of 7 TRALI cases with 4 controls per case, matched by strata for volume of plasma transfused. All cases identified by the Transfusion Biology and Medicine Specialized Center of Clinically Oriented Research with a TRALI diagnosis were eligible for inclusion. Electronic medical records and operative notes were reviewed to obtain demographic data, diagnosis, surgical approach, and number of spine levels for each operation. Results: An increased prevalence of maternal blood transfusion was found among the TRALI cases compared with the control cases: 43% (3 of 7) versus 7% (2 of 28), P = 0.044. There were otherwise no statistical differences between the groups, including age, gender, surgical approach, number of spinal levels, or type of blood product transfused. Conclusion: Pediatric patients undergoing spinal surgery may be at increased risk for the development of TRALI following the transfusion of maternal blood products. Accordingly, we recommend that directed donation of maternal blood products should be avoided in this population. This study also found that TRALI may be underrecognized and underreported to the transfusion service.
MeSH term(s)	Acute Lung Injury/etiology ; Adolescent ; Blood Donors ; Case-Control Studies ; Child ; Female ; Humans ; Male ; Retrospective Studies ; Risk Factors ; Transfusion Reaction
Language	English
Publishing date	2010-10-08
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	752024-4
ISSN	1528-1159 ; 0362-2436
ISSN (online)	1528-1159
ISSN	0362-2436
DOI	10.1097/BRS.0b013e3181e3dad2
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Article ; Online: Cost minimization analysis of preoperative erythropoietin vs autologous and allogeneic blood donation in total joint arthroplasty.

Green, William Scott / Toy, Pearl / Bozic, Kevin J

The Journal of arthroplasty

2010 Volume 25, Issue 1, Page(s) 93–96

Abstract: Autologous blood donation and erythropoietin (EPO) have been shown to be effective in reducing allogeneic blood transfusion, but the cost-effectiveness of these interventions remains unclear. A cost minimization analysis was performed, comparing the ... ...

Abstract	Autologous blood donation and erythropoietin (EPO) have been shown to be effective in reducing allogeneic blood transfusion, but the cost-effectiveness of these interventions remains unclear. A cost minimization analysis was performed, comparing the total costs of allogeneic blood transfusion strategy and autologous and allogeneic blood transfusion strategy for 161 primary total hip arthroplasty (THA) and 195 total knee arthroplasty (TKA) patients. An EPO cost minimization model was constructed using a previously published algorithm for blood management after total joint arthroplasty. The least costly strategy was autologous blood donation in combination with allogeneic blood for THA and TKA patients at $856 and $892 per patient, respectively. The most costly strategy was allogeneic only at $1769 and $1352 per THA and TKA patient, respectively. The EPO strategy model predicted costs similar to the autologous and allogeneic. A strategy that combines autologous blood donation with EPO for patients who cannot donate autologous blood may provide the greatest cost savings and minimize allogeneic blood transfusion.
MeSH term(s)	Arthroplasty, Replacement, Hip ; Arthroplasty, Replacement, Knee ; Blood Transfusion/economics ; Blood Transfusion, Autologous/economics ; Cost Savings ; Cost-Benefit Analysis ; Costs and Cost Analysis ; Erythropoietin/administration & dosage ; Erythropoietin/economics ; Hemoglobins/analysis ; Humans ; Middle Aged ; Preoperative Care ; Recombinant Proteins
Chemical Substances	Hemoglobins ; Recombinant Proteins ; Erythropoietin (11096-26-7)
Language	English
Publishing date	2010-01
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2008.10.005
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