Incidence of Transfusion Complications in Noncardiac Surgery Patients

Published in Anesthesiology 2015 Jan 122:21

Authors: Clifford L et al.

Transfusion-related acute lung injury and transfusion-associated circulatory overload occurred in several percent of transfused patients.

Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are important causes of morbidity and mortality in transfused patients. Mayo Clinic researchers conducted two retrospective studies to determine the incidence of TRALI and TACO in noncardiac surgery patients who received intraoperative blood-product transfusions in 2004 and 2011; these 2 years were chosen to determine whether incidences changed after the blood bank had implemented two strategies to mitigate TRALI in the intervening years (leukoreduced transfusions and use of male-only plasma donors).

The electronic records of about 4000 patients who received intraoperative transfusions initially were screened for possible TRALI or TACO through a complex search strategy; cases then were confirmed or excluded by manual chart review, according to published criteria for these disorders. Cases were included only if symptoms began within 6 hours after the last intraoperative transfusion.

Incidences of TRALI in 2004 and 2011 were 1.3% and 1.4%, respectively; incidences of TACO were 5.5% and 3.0%, respectively. Risk for both TRALI and TACO increased as the volume of transfused blood product increased. Half the patients with TRALI also met criteria for TACO, and 13% of those with TACO met TRALI criteria.

Comment
Using retrospective record review to identify and distinguish between TRALI and TACO is challenging: Clinical characteristics of the two entities overlap both with each other and with other perioperative pulmonary disorders. Nevertheless, these estimates probably are as good as any that currently exist in the medical literature. Interestingly, the incidence of TRALI did not change despite the blood bank’s implementation of TRALI-mitigation strategies between the 2 study years.