Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Post transfusion lung injury in the neonatal population

Journal of Perinatology volume 33, pages 292–296 (2013)Cite this article

Subjects

Abstract

Objective:

The objective of this study was to examine the changes in level of respiratory support following transfusion in neonates who require intermediate or intensive care.

Study Design:

Data on respiratory support were collected retrospectively from the medical record before, during and after transfusion. Neonatal post transfusion lung injury (NPTLI) was defined as an increase in the highest mean airway pressure (MAP) of ⩾2 cm H2O or FiO2 >0.15 in the 6-h after transfusion that persisted from 6 to 18 h post transfusion.

Result:

A total of 373 (330 packed red blood cell) transfusions were given to 108 infants. NPTLI occurred following 31 (8.3%) transfusions in 23 patients. During the first 6 h after transfusion, FiO2 or MAP was increased in 47 transfusions (12.6%) and the changes persisted in 31 transfusions (7.8%). Infants who developed NPTLI were less mature (27.1±0.7 vs 31.0±0.5 weeks; P=0.005) and of lower birth weight (1001±110 vs1692±104 g; P=0.001). Infants who developed NPTLI were more likely to develop necrotizing enterocolitis (6/24 vs 4/85; P=0.002) and die within 24 h of transfusion (5/22 vs 3/85; P=0.003).

Conclusion:

In neonates receiving intensive or intermediate care, blood transfusion was associated with need for increased respiratory support in a significant number of cases. Development of NPTLI was associated with poorer outcomes.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Lanman JT, Bierman HR, Byron RL . Transfusion of leukemic leukocytes in man: hematologic and physiologic changes. Blood 1950; 5 (12): 1099.

    CAS  PubMed  Google Scholar 

  2. Barnard RD . Indiscriminate transfusion: a critique of case reports illustrating hypersensitivity reactions. N Y State J Med 1951; 51 (20): 2399–2402.

    CAS  PubMed  Google Scholar 

  3. Citak EC, Kesik V, Atay AA, Sari E, Kismet E, Koseoglu V . Transfusion-related acute lung injury in a child with neuroblastoma during a late engraftment period of autologous stem cell transplantation. Pediatr Tranplant 2008; 12 (2): 235–237.

    Article  Google Scholar 

  4. Church GD, Price C, Sanchez R, Looney MR . Transfusion-related acute lung injury in the paediatric patient: Two case reports and a review of the literature. Transfus Med 2006; 16 (5): 343–348.

    Article  CAS  Google Scholar 

  5. Gauvin F, Lacroix J, Robillard P, Lapointe H, Hume H . Acute transfusion reactions in the pediatric intensive care unit. Transfusion 2006; 46 (11): 1899–1908.

    Article  Google Scholar 

  6. Sanchez R, Toy P . Transfusion related acute lung injury: a pediatric perspective. Pediatr Blood Cancer 2005; 45 (3): 248–255.

    Article  Google Scholar 

  7. Holness L, Knippen M, Simmons L, Lachenbruch P . Fatalities caused by TRALI. Transfus Med Rev 2004; 18 (3): 184–188.

    Article  Google Scholar 

  8. Kopko PM, Marshall CS, Mackenzie MR, Holland PV, Popovsky MA, Page P . Transfusion-related acute lung injury report of a clinical look-back investigation. JAMA 2002; 287 (15): 1968–1971.

    Article  Google Scholar 

  9. Toy P, Popovsky MA, Abraham E, Ambruso DR, Holness LG, Kopko PM et al. Transfusion-related acute lung injury: definition and review. Crit Care Med 2005; 33 (4): 721–726.

    Article  Google Scholar 

  10. Wallis JP . Transfusion-realated acute lung injury (TRALI)-under-diagnosed and under-reported. Br J Anaesth 2003; 90 (5): 573–576.

    Article  CAS  Google Scholar 

  11. Goldman M, Webert KE, Arnold DM, Freedman J, Hannon J, Blajchman MA . Proceedings of a consensus conference: towards an understanding of TRALI. Transfus Med Rev 2005; 19 (1): 2–31.

    Article  Google Scholar 

  12. Kleinman S, Caulfield T, Chan P, Davenport R, McFarland J, McPhedran S et al. Toward an understanding of transfusion-related acute lung injury: statement of a consensus panel. Transfusion 2004; 44 (12): 1774–1789.

    Article  Google Scholar 

  13. Zilberberg MD, Carter C, Lefebvre P, Raut M, Vekeman F, Duh MS et al. Red blood cell transfusions and the risk of acute respiratory distress syndrome among the critically ill: a cohort study. Critical care (London, England) 2007; 11 (3): R63.

    Article  Google Scholar 

  14. Higgins S, Fowler R, Callum J, Cartotto R . Transfusion-related acute lung injury in patients with burns. J Burn Care Res 2005; 28 (1): 56–64.

    Article  Google Scholar 

  15. Bux J, Becker F, Seeger W, Kilpatrick D, Chapman J . Waters a. Transfusion-related acute lung injury due to HLA-A2-specific antibodies in recipient and NB1-specific antibodies in donor blood. Br J Haematol 1996; 93 (3): 707–713.

    Article  CAS  Google Scholar 

  16. Kopko PM . Leukocyte antibodies and biologically active mediators in the pathogenesis of transfusion-related acute lung injury. Curr Hematol Rep 2004; 3 (6): 456–461.

    PubMed  Google Scholar 

  17. Nicollea L, Chapman CE, Carter V, Wallis JP . Transfusion-related acute lung injury caused by two donors with anti-human leucocyte antigen class II antibodies: a look-back investigation. Transfus Med (Oxford, England) 2004; 14 (3): 225–230.

    Article  Google Scholar 

  18. Sachs U, Hattar K, Weissmann N, Bohle RM, Weiss T, Sibelius U et al. Antibody-induced neutrophil activation as a trigger for transfusion-related acute lung injury in an ex vivo rat lung model. Blood 2006; 107 (3): 1217.

    Article  CAS  Google Scholar 

  19. Nishimura M, Hashimoto S, Takanashi M, Okazaki H, Satake M, Nakajima K . Role of anti-human leucocyte antigen class II alloantibody and monocytes in development of transfusion-related acute lung injury. Transfus Med (Oxford, England) 2007; 17 (2): 129–134.

    Article  CAS  Google Scholar 

  20. Nishimura M, Ishikawa Y, Satake M . Activation of polymorphonuclear neutrophils by immune complex: possible involvement in development of transfusion-related acute lung injury. Transfus Med (Oxford, England) 2004; 14 (5): 359–367.

    Article  CAS  Google Scholar 

  21. Nishimura M, Mitsunaga S, Ishikawa Y, Satake M . Possible mechanisms underlying development of transfusion-related acute lung injury: roles of anti-major histocompatibility complex class II DR antibody. Transfus Med (Oxford, England) 2003; 13 (3): 141–147.

    Article  CAS  Google Scholar 

  22. Nishimura M, Takanashi M, Okazaki H, Satake M . Lung microvascular endothelial cell injury caused by treatment with polymorphonuclear neutrophils and low-IgM serum: a model of transfusion-related acute lung injury. Lung 2006; 184 (1): 25–32.

    Article  Google Scholar 

  23. Silliman CC . The two-event model of transfusion-related acute lung injury. Crit Care Med 2006; 34 (5 Suppl): S124–S131.

    Article  Google Scholar 

  24. Silliman CC, Bjornsena J, Wyman TH, Kelher M, Allard J, Bieber S et al. Plasma and lipids from stored platelets cause acute lung injury in an animal model. Transfusion 2003; 43 (5): 633–640.

    Article  Google Scholar 

  25. Silliman CC, Paterson AJ, Dickey WO, Stroncek DF, Popovsky MA, Caldwell SA et al. The association of biologically active lipids with the development of transfusion-related acute lung injury: a retrospective study. Transfusion 1997; 37 (7): 719–726.

    Article  CAS  Google Scholar 

  26. Wu TJ, Teng RJ, Tsou Yau KI . Transfusion-related acute lung injury treated with surfactant in a neonate. Eur J Pediatr 1996; 155 (7): 589–591.

    Article  CAS  Google Scholar 

  27. O’Connor JC, Strauss RG, Goeken NE, Knox LB . A near-fatal reaction during granulocyte transfusion of a neonate. Transfusion 1988; 28 (2): 173–176.

    Article  Google Scholar 

  28. Greenhouse SW, Geisser S . On methods in the analysis of profile data. Psychometrika 1959; 24 (2): 95–111.

    Article  Google Scholar 

  29. Hébert PC, Wells G, Blajchman MA, Arshall JM, Martin CL, Pagliarello GI et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 1999; 340 (13): 1056–1056.

    Google Scholar 

  30. Croce M a., Tolley E a., Claridge J a., Fabian TC . Transfusions result in pulmonary morbidity and death after a moderate degree of injury. J Trauma 2005; 59 (1): 19–24.

    Article  Google Scholar 

  31. Marik PE, Corwin HL . Acute lung injury following blood transfusion: expanding the definition. Crit Care Med 2008; 36 (11): 3080–3084.

    Article  Google Scholar 

  32. Khan H, Belsher J, Yilmaz M, Afessa B, Winters JL, Moore SB et al. Fresh-frozen plasma and platelet transfusions are associated with development of acute lung injury in critically ill medical patients. Chest 2007; 131 (5): 1308–1314.

    Article  Google Scholar 

  33. Popovsky MA . The Emily Cooley Lecture 2009 To breathe or not to breathe-that is the question. Transfusion 2010; 50: 2057–2062.

    Article  Google Scholar 

  34. Popovsky MA . Pulmonary consequences of transfusion: TRALI and TACO. Transfus Apheresis Sci 2006; 34 (3): 243–244.

    Article  Google Scholar 

  35. Paul D a, Mackley A, Novitsky A, Zhao Y, Brooks A, Locke RG . Increased odds of necrotizing enterocolitis after transfusion of red blood cells in premature infants. Pediatrics 2011; 127 (4): 635–641.

    Article  Google Scholar 

  36. Christensen RD, Lambert DK, Henry E, Wiedmeier SE, Snow GL, Baer VL et al. Is “transfusion-associated necrotizing enterocolitis” an authentic pathogenic entity? Transfusion 2009; 50 (5): 1106–1112.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank Kim Kwitkowski and Val Cook for their help in reviewing patients charts. The study received funding from the Manitoba Institute of Child Health.

Author contributions

F Al-Sufayan developed the original study design, ethics submissions and reviewed patient charts; N Rashid revised the original study design, reviewed patients charts and wrote the first draft of the manuscript; MML Seshia assisted in the study design and review of manuscript; RJ Baier assisted in the study design, performed statistical analysis, prepared figures, final editing and preparation of manuscript.

Author information

Authors and Affiliations

  1. Department of Paediatrics and Child Health, University of Manitoba, CS 408 Health Sciences Centre, Winnipeg, MB, Canada

    N Rashid, F Al-Sufayan, M M K Seshia & R J Baier

Authors
  1. N Rashid
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F Al-Sufayan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M M K Seshia
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R J Baier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R J Baier.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rashid, N., Al-Sufayan, F., Seshia, M. et al. Post transfusion lung injury in the neonatal population. J Perinatol 33, 292–296 (2013). https://doi.org/10.1038/jp.2012.114

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2012.114

Keywords

This article is cited by

Search

Advanced search

Quick links