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Archivos de Pediatría del Uruguay

Print version ISSN 0004-0584On-line version ISSN 1688-1249


TORRES, Deborah; SILVERA, Fernando  and  BORBONET, Daniel. TRALI in newborns. Clinical case report. Arch. Pediatr. Urug. [online]. 2018, vol.89, n.4, pp.264-270. ISSN 0004-0584.

Newborns, especially preterm newborns, are one of the age groups that receive the most hemoderivatives. Although the progress made in the field of hemotherapy have made it possible to reduce the risks associated with transfusions, in some cases there are still complications1,2.

TRALI (transfusion related acute lung injury) is a rare but potentially serious complication. It was initially detected in adults, though cases were later described in children. In newborns, only one case has been confirmed and published globally. The actual incidence is uncertain, given the insufficient knowledge of the pathology and the fact that findings have been under reported. TRALI results from pulmonary vascular endothelial damage and causes pulmonary edema and subsequent hypoxemia. Treatment is observed with supportive treatment3. Prevention is mainly based on the permanent review of the hemoderivatives' transfusion directives and on the fluent communication among members of the hemotherapy medical team in order to ensure a timely diagnosis.

The clinical case described below is that of a preterm newborn who, during a transfusion of red blood cell concentrate, showed hypoxemia, hemodynamic alterations and fever and required mechanical ventilatory support. Infectious processes were ruled out. Chest X-Rays showed infiltrates compatible with pulmonary edema. Heart failure was ruled out. The treatment was performed to support vital functions. The evolution was favorable in the course of 72 hours. The case was reported to the Hemotherapy Service. Blood component transfusion guidelines should be regularly reviewed in order to prevent the performance of unnecessary transfusions.

Keywords : Transfusion-related acute lung injury; Transfusion reaction; Premature infant.

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