TRALI en paciente oncológico. Caso clínico

Introduction: Transfusion related acute lung injury (TRALI) is an adverse reaction to blood transfusion. Reported risk in TRALI per blood component issued prior to 2004 in the UK was 1:556,000 per red cells in optimal additive solutions, German informs 1: 5000 with a mortality who reported fatality cause rate of 6 to 9%. In the USA, from 2004 to 2006 TRALI has been the first cause of death associated with blood transfusion. In Mexico, there is not statistical published information. Clinical case: GSM is a 38 years old female patient, with a diagnosis of colon cancer, who presented an adverse reaction to the transfusion in July 27, 2008 at 20:45 hours whith a concentrate to red cells concentrate transfusion (approximately 50 mL) group O Rh (o) D: positive, 30 minutes later she presented: cough, bronchial secretion, difficulty breath, tremors and shivers; the transfusion was suspended. Vital signs: (before and during) blood pressure: 110/70 mmHg, cardiac frequency: 80 per minute and temperature: 37.5 °C. The medical treatment to the patient was based on hydrocortisone sodium succinate 100 mg and diphenhydramine hydrochloride 25 mg both intravenosous and oxygen therapy, yielding partially the clinical course in 24 hours. Transfusion antecedents: 10 concentrates of red blood cells in the period that includes from 2000 to 2008. Laboratory. Results: blood biometry Resumen Antecedentes: TRALI es el acrostico de T = transfusion, R = related, A = acute, L = lung, I = injury. El riesgo estimado reportado en la literatura inglesa es 1:557,000 para globulos rojos y la alemana en general informa que es de 1:5,000 con una mortalidad del 6 al 9%. En Estados Unidos, de 2004 a 2006 fue la primera causa de muerte asociada a transfusion sanguinea. En Mexico no hay datos estadisticos publicados. Caso clinico: Mujer de 38 anos de edad, con diagnostico de cancer de colon, la cual presento reaccion adversa a la transfusion el dia 27 de julio del 2008 a las 20:45 horas posterior a la transfusion de 50 mL de un concentrado eritrocitario grupo O Rho(D): positivo (con pruebas de compatibilidad pretransfusional compatibles) el cual fue indicado por sindrome anemico secundario al diagnostico neoplasico. Despues de 30 minutos presento tos, secrecion bronquial, disnea, escalofrios y temblor, por lo que se suspende de inmediato la transfusion. Los signos vitales antes y despues de la transfusion fueron los siguientes: Presion arterial 110/70 mmHg, frecuencia cardiaca 80 latidos por minuto, temperatura 37.5 o C. Inmediatamente se