A Systematic Review on the Management of Transfusion-Related Acute Lung Injury in Transfusion-Dependent Sickle Cell Disease.

Hadia Arzoun,Bridget Lee,Siji S Thomas,Alena Yarema,Mirra Srinivasan,Mona Adam

doi:10.7759/cureus.22101

Abstract

The onset of respiratory distress and acute lung injury (ALI) following a blood transfusion is known as transfusion-related acute lung injury (TRALI), although its pathophysiology remains unknown. Even though sickle cell disease (SCD) has been studied for more than a century, few therapeutic and management strategies adequately address the emergence of TRALI. TRALI, an immune-mediated transfusion response that can result in life-threatening consequences, is diagnosed based on clinical signs and symptoms. Early detection and treatment increase the chances of survival and, in most cases, result in a complete recovery. Our objective is to provide a firm grasp of the present status of SCD-related TRALI care and therapy.After exploring multiple databases, this study offers evidence-based guidelines to aid clinicians and other healthcare professionals make decisions concerning transfusion assistance for SCD and the management of transfusion-related complications. Other risk factors for acute lung injury including sepsis aspiration should be ruled out throughout the diagnostic process. Several recent studies have shown that immunotherapy or immunological targets can effectively prevent these complications. Red cell transfusions, red cell antigen matching optimization, and iron chelation can also help reduce negative consequences. It is to be noted that poor clinical outcomes can be avoided by early detection and treatment of hemolytic transfusion reactions. Finally, preventing the onset of TRALI may be the most effective therapeutic strategy for SCD patients who rely on blood transfusions for survival.

Highlights

BackgroundSickle cell disease (SCD) is a disease in which the appearance of red blood cells takes on the shape of a sickle [1]
The emergence of transfusion-related acute lung injury (TRALI) [5], which is defined as acute pulmonary edema following transfusion in the absence of circulatory overload or other acute respiratory distress syndrome (ARDS) risk factors [6], is a major complication associated with blood transfusion in sickle cell disease (SCD) patients
TRALI can be diagnosed earlier if clinicians are aware of the disorder and have a high index of suspicion

Summary

Introduction

BackgroundSickle cell disease (SCD) is a disease in which the appearance of red blood cells takes on the shape of a sickle [1]. Common treatment protocols, such as blood transfusions, can result in complications and adverse effects, among those dependent on transfusions [4]. The emergence of transfusion-related acute lung injury (TRALI) [5], which is defined as acute pulmonary edema following transfusion in the absence of circulatory overload or other acute respiratory distress syndrome (ARDS) risk factors [6], is a major complication associated with blood transfusion in SCD patients. Treatment and management options primarily revolve around supportive care modalities and preventative measures. Apart from the disease complications, treatment-related adverse effects occur, especially in those who require frequent blood transfusions, most commonly presenting as TRALI [5]. To enhance the health and life span of these individuals, complications associated with the disease and treatment require effective management strategies

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Methods

Conclusion