Dengue Special Transfusion-related acute lung injury (TRALI)

Health Care, Medicine, Social Health Community 1,948 Comments

Transfusion of even one unit of a plasma-containing blood product sometimes causes acute lung injury/acute respiratory distress syndrome (ALI/ARDS).(1,2)

What can cause TRALI: Fresh frozen plasma, platelet, and packed red blood cell transfusions?

Definition: New ALI occurring during or within 6 hours after a transfusion.

Pathogenesis: A “two-event” hypothesis holds that recipient granulocytes are primed, either by transfused active substances or by virtue of the patient’s underlying clinical condition. Preformed anti-leukocyte antibodies contained in the transfusion product then “activate” these functionally hyperactive granulocytes.

Which donors: Anti-leukocyte antibodies are more likely to be found in blood donated by multiparous women due to sensitization to fetal antigens during pregnancy.

When to suspect: Whenever dyspnea, hypoxemia, and pulmonary infiltrates occur during or within 6 hours after transfusion of any plasma-containing blood product.

Differential diagnosis

  • Transfusion-associated circulatory overload
  • Hemolytic transfusion reaction
  • Anaphylaxis of IgA-containing products to a IgA deficiency recipient

Management: Supportive (mechanical ventilation, supplemental oxygen, diuretics when volume overload is present). Clinical improvement will occur spontaneously as lung injury resolves.

Action: Individuals who have developed TRALI should receive no further plasma-containing blood products from the implicated donor.

Prevention

  • Take plasma products only from male donors
  • Screen previously-pregnant and previously-transfused apheresis donors for HLA antibodies
  • Start testing for the detection of white blood cell antibodies

References

  1. Bux J, Sachs UJ. The pathogenesis of transfusion-related acute lung injury (TRALI). Br J Haematol 2007;136:788.
  2. Khan H, Belsher J, Yilmaz M, et al. Fresh-frozen plasma and platelet transfusions are associated with development of acute lung injury in critically ill medical patients. Chest 2007;131:1308.

Strenuous exercise may increase risk of cardiac disorders

Health Care, Medicine 1,944 Comments

Strenuous exercise, whether performed by elite athletes or competitive weekend warriors, comes with a risk of developing cardiac disorders, including atrial fibrillation, according to a study presented at the European Society of Cardiology meeting.

Investigators found that among people who exercise four hours or more during the week, there was about a 39% increased risk of developing atrial fibrillation that required medical treatment.

Among elite cross-country endurance skiers, the risk of developing arrhythmias increased by 37% when compared with athletes in the same race that skied at a more moderate pace.

Source: Med Page Today

FDA Warning: Test kidney function before prescribing Zoledronic acid

Health Care, Medicine 230 Comments

FDA  has updated a warning regarding kidney failure and use of zoledronic acid. Kidney failure is a rare but serious condition associated with its use in patients with a history of or risk factors for kidney impairment.

Doctors are being warned to check patient kidney function before prescribing zoledronic acid and to check those who are already taking the drug.

The new warning indicates that patients with creatinine clearance of less than 35 mL/min or evidence of acute renal impairment should not be given zoledronic acid for osteoporosis.

The warning also lists risk factors including advanced age, concurrent treatment with other nephrotoxic drugs, and dehydration secondary to fever, sepsis, gastrointestinal losses, or diuretic therapy.

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