The incidence, risk factors, and outcome of transfusionrelated acute lung injury in a cohort of cardiac surgery patients: a prospective nested case-control study

Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related morbidity and mortality. Both antibodies and bioactive lipids that have accumulated during storage of blood have been implicated in TRALI pathogenesis. In a single-center, nested, casecontrol study, patients were prospectively observed for onset of TRALI according to the consensus definition. Of 668 patients, 16 patients (2.4%) developed TRALI. Patient-related risk factors for onset of TRALI were age and time on the cardiopulmonary bypass. Transfusion-related risk factors were total amount of blood products (odds ratio = 1.2; 95% confidence interval [CI], number of red blood cells stored more than 14 days = total amount of plasma = of antibodies in donor plasma = and total amount of transfused bioactive lipids (OR = CI, When adjusted for patient risk factors, the of antibodies in the associated blood products risk factor for TRALI = In-hospital mortality of TRALI 13% compared with 0% and 3% in transfused and nontransfused patients, respectively (P < .05). In conclusion, the incidence of TRALI is high in cardiac surgery patients and associated with adverse Our results suggest that cardiac surgery patients may benefit from exclusion of blood products containing HLA/HNA the lipid was injected on the HPLC-MS/MS system. Chromatographic separation was achieved on a modular HPLC system (Surveyor; Thermo Finnigan) consisting of a cooled autosampler (T = 12°C), a low-flow quaternary MS pump and analytical HPLC column: LichroSpher Si60, 2 × 250-mm column, 5- μ m particle diameter (Merck). Samples were eluted with a flow rate of 300 μ L/minute and a programmed linear gradient between solution B (chloroform-methanol, 97:3, vol/vol) and solution A (methanol-water, 85:15, vol/vol); A and B contained 1 mL and 0.1 mL of 25% (vol/vol) aqueous ammonia per liter of eluent, respectively. The gradient was: T = 0 to 10 minutes: 20% A to 100% A; T = 10 to 12 minutes, 100% A; T = 12 to 12.1 minutes: 100% A to 0% A; and T = 12.1 to 17 minutes, equilibration with 0% A. Total run-time, including the equilibration, was 17 minutes. A splitter between the HPLC and MS was used for the

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