Incidence of Transfusion-Related Acute Lung Injury Temporally Associated With Solvent/Detergent Plasma Use In The ICU - A Retrospective Before and After Implementation Study

Abstract

\n Background: Transfusion-related acute lung injury (TRALI) is a severe complication of plasma transfusion, though use of solvent/detergent pooled plasma (SDP) has nearly eliminated reported TRALI cases. The goal of this study was to investigate TRALI incidence in the intensive care unit (ICU) following replacement of quarantined, male-only, fresh frozen plasma (qFFP) by SDP for routine use. Methods:We conducted a retrospective multicenter observational before-after cohort study during two six-month periods, before (April to October 2014) and after introduction of SDP (April to October 2015), taking into account a six-month wash-out period. One secondary and four tertiary academic hospitals participated.Results:Admitted to the ICU were 8944 patients during both inclusion periods. 1171 qFFP units were transfused in 376 patients in the qFFP, and 396 during the before and after periods respectively in the SDP period. A full patient chart review was performed in 300 patients that received ≥1 units of plasma and had a PaO2/FiO2-ratio (P/F-ratio) <300 within 24 hours. Ten cases of TRALI occurred during the qFFP and nine cases during the SDP period, in which plasma was transfused concomitantly with other products, or alone. The incidence was 0.85% (CI95%: 0.33% – 1.4%) per unit qFFP and 0.45% (CI95%: 0.21% - 0.79%, p = 0.221) per SDP-unit. One instance of TRALI occurring after a single SDP unit. Mortality was 70% for patients developing TRALI in the ICU compared to 22% in all patients receiving at least one plasma transfusion. Conclusion:Implementation of SDP lowered the incidence of TRALI in which plasma products were implicated, though not significantly. TRALI can still occur as a result of SDP transfusion. Developing TRALI in the ICU was associated with high mortality rates, therefore clinicians should remain vigilant.