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Transfusion-related acute lung injury or acute chest syndrome of sickle cell disease? – A case report

[Une étude de cas : lésion pulmonaire aiguë post-transfusionnelle ou syndrome pulmonaire aigu de la drépanocytose ?]

Paul G. Firth, MBCHB^*, Yoshihiko Tsuruta, MD^*, Yogish Kamath, MD, Walter H. Dzik, MD, Christopher S. Ogilvy, MD and Robert A. Peterfreund, MD PhD^*

^* From the Departments of Anesthesia and Critical Care,
Neurosurgery,
and the Blood Transfusion Service, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.

Address correspondence to: Dr. Paul G. Firth, Nuffield Department of Anaesthetics, Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE, United Kingdom. Phone: 01 86 572 7342; Fax: 01 86 579 4191; E-mail: pfirth{at}partners.org

Purpose: To describe how to differentiate transfusion-related acute lung injury from acute chest syndrome of sickle cell disease.

Clinical features: A neurosurgical patient with sickle cell disease received two units of packed red blood cells postoperatively. Four hours later she developed progressive respiratory distress, diffuse geographical airspace disease and bilateral pulmonary edema. The patient recovered sufficiently to be transferred from the intensive care unit within four days. The temporal relationship to transfusion, features on computerized tomographic scan, and the rapid resolution of severe edema point to a diagnosis of transfusion related acute lung injury. Granulocyte or human leukocyte antigen antibodies in donor plasma may confirm a diagnosis of transfusion injury.

Conclusion: The clinician should appreciate that erythrocyte transfusion to prevent or treat acute chest syndrome may cause transfusion related acute lung injury, a condition that mimics, exacerbates or possibly triggers the syndrome it was intended to treat.

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