Ryu Yanagisawa1, Seiki Abe2, Ikuko Fujihara3, Kazutoshi Komori4, Yoshiaki Kondo5, Kazuo Sakashita3, Tomohiko Nakamura6. 1. Life Science Research Center, Nagano Children's Hospital, Azumino, Japan; Division of Blood Transfusion, Shinshu University Hospital, Matsumoto, Japan; Center for Advanced Cell Therapy, Shinshu University Hospital, Matsumoto, Japan. Electronic address: ryu@shinshu-u.ac.jp. 2. Department of Anesthesia, Nagano Children's Hospital, Azumino, Japan. 3. Department of Hematology/Oncology, Nagano Children's Hospital, Azumino, Japan. 4. Department of Hematology/Oncology, Nagano Children's Hospital, Azumino, Japan; Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan. 5. Department of Radiology, Nagano Children's Hospital, Azumino, Japan. 6. Life Science Research Center, Nagano Children's Hospital, Azumino, Japan; Division of Neonatology, Nagano Children's Hospital, Azumino, Japan.
Abstract
BACKGROUND: Although several types of transfusion-related adverse reactions (TRARs) have been reported, one of the most important involves respiratory features during and after blood transfusion. Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are the most severe adverse events following blood transfusion, whereas transfusion-associated dyspnea (TAD) is a less severe respiratory distress. However, there exists little evidence of these factors in pediatric populations. CASE REPORT: Here, two cases of atypical TRARs with respiratory features, in pediatric patients with solid tumors, appearing after transfusion of platelet concentrate following autologous peripheral blood stem cell transplantation are reported. Both patients developed mild hypoxemia during PC transfusion, which continued for approximately 2 weeks. Chest radiography in either patient did not reveal any abnormalities that are included in the criteria of either TRALI or TACO. Both patients recovered following oxygen administration. CONCLUSION: This complication of TRARs with respiratory features may occur more frequently in pediatric populations than realized because it may be under-recognized or under-reported. Accumulation of additional cases, including non-typical cases, is necessary to fully understand the pathology of TRARs, correctly classify these reactions, and improve care of patients receiving blood transfusions.
BACKGROUND: Although several types of transfusion-related adverse reactions (TRARs) have been reported, one of the most important involves respiratory features during and after blood transfusion. Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are the most severe adverse events following blood transfusion, whereas transfusion-associated dyspnea (TAD) is a less severe respiratory distress. However, there exists little evidence of these factors in pediatric populations. CASE REPORT: Here, two cases of atypical TRARs with respiratory features, in pediatric patients with solid tumors, appearing after transfusion of platelet concentrate following autologous peripheral blood stem cell transplantation are reported. Both patients developed mild hypoxemia during PC transfusion, which continued for approximately 2 weeks. Chest radiography in either patient did not reveal any abnormalities that are included in the criteria of either TRALI or TACO. Both patients recovered following oxygen administration. CONCLUSION: This complication of TRARs with respiratory features may occur more frequently in pediatric populations than realized because it may be under-recognized or under-reported. Accumulation of additional cases, including non-typical cases, is necessary to fully understand the pathology of TRARs, correctly classify these reactions, and improve care of patients receiving blood transfusions.