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TRALI vs. TACO

先聲明,今天不是要談章魚(TACO),今天要談談輸血反應。Transfusion related acute lung injury (TRALI)和transfusion-associated circulatory overload (TACO)臨床上很難區分,以下的方法可能會有所幫助(摘自Crit Care Med 2006;34(5 Suppl):S109-113):

  • Pulmonary edema-to-plasma protein concentration greater than 0.65;
  • Pulmonary artery occlusion pressure less than 18 mmHg;
  • B-type natriuretic peptide (BNP) lower than 250 pg/mL or pre-or post-transfusion BNP ratio below 1.5;
  • Lack of improvement with preload reduction (with either diuretics or positive pressure ventilation); and
  • Presence of two of three less accurate measurements to distinguish hydrostatic from nonhydrostatic pulmonary edema (systolic ejection fraction >45 and no valvular heart disease; systolic blood pressure <160 mmHg; or vascular pedicle width < 65 mm and cardiothoracic ratio < 0.55 on chest x-ray).
  • If all clinical indications are consistent with nonhydrostatic pulmonary edema, and there is no other risk factor for ALI, the likely diagnosis is TRALI

 


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