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Impact of immunoreactive substances contained in apheresis platelet concentrate on postoperative respiratory function in surgical patients receiving platelet transfusion: a prospective cohort study
Author(s) -
Kanai R.,
Iijima T.,
Hashimoto S.,
Nakazawa H.,
Ohnishi H.,
Yorozu T.,
Ohkawa R.,
Nojiri T.,
Shimizu M.,
Okazaki H.
Publication year - 2013
Publication title -
transfusion medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.471
H-Index - 59
eISSN - 1365-3148
pISSN - 0958-7578
DOI - 10.1111/tme.12056
Subject(s) - medicine , transfusion related acute lung injury , odds ratio , confidence interval , platelet transfusion , blood transfusion , chest radiograph , cohort , perioperative , prospective cohort study , platelet , pulmonary function testing , lung , anesthesia , surgery , pulmonary edema
SUMMARY Objectives To construct an alternative policy for the donor selection of platelet concentrate ( PC ), a clinical study exploring the features of lung injury following PC administration is needed. Background Although a male‐donor‐only policy for plasma products appears to have efficiently reduced transfusion‐related acute lung injury ( TRALI ), this policy may not be applied to PC because of supply shortages. Methods and Materials We prospectively examined pulmonary function after the transfusion of PC in informed surgical patients treated at a tertiary university hospital in Japan. The contributions of immunoreactive substances contained in the PC to respiratory function after PC transfusion was then statistically examined. Results Eighty‐six patients (56 men, 30 women) were enrolled in the analysis. Fifty‐four cases experienced respiratory failure ( PaO 2 / FiO 2 <300 mmHg) after transfusion. Five cases were diagnosed as possible TRALI based on permeability pulmonary oedema, while 23 cases were diagnosed as transfusion‐associated circulatory overload ( TACO ) based on chest radiograph findings. A multivariate logistic regression analysis identified the presence of anti‐granulocyte antibody as a significant predictor of possible TRALI [ P = 0·023; odds ratio ( OR ), 13·0; 95% confidence interval ( CI ), 1·4–118·3]. Meanwhile, anti‐leukocyte antibody class II was identified as a significant independent predictor of TACO ( P = 0·010; OR , 18·4; 95% CI , 2·0–170·1). Conclusions Our data suggest that antibodies contained in PC may contribute to the deterioration of respiratory function after PC transfusion, although the diagnoses of TACO and TRALI may have overlapped among the patients with pulmonary distress in this cohort.