Transfusion related acute lung injury (TRALI) has insidiously become the leading cause of transfusion linked deaths in the United States and most other developed countries. Its frequently was only recognized thanks to Serious Hazards of Transfusion (SHOT), a British hemovigilance system. It took note of an upward trending of deaths occurring after transfusion and hallmarked by lung complications. Although experts and major stake holders in the field are continually being convened to iron out a consensual definition of TRALI, the current working definition of TRALI is, a life-threatening adverse effect of transfusion characterized by development of acute respiratory distress with hypoxemia during or up to 6 hours after completion of a blood transfusion.
The first documented case of TRALI was in 1951. In this originating case, TRALI was described as a hypersensitivity causing lung complications (1). Other encounters with TRALI yielded an array of other descriptive terms until 1985 when the Mayo Clinic came up with the word TRALI to define acute respiratory distress with lung edema that followed transfusion of blood or blood products. The first fatality of TRALI was reported to the Center for Biologics Evaluation and Research (CBER) in 1992. Since then, the number of deaths caused by TRALI has gradually and consistently rose. Between 1992 when the first reported fatality was reported and the fiscal year 2000, there were 45 more deaths. The latest figures from CBER for fiscal year 2008 to 2012 confirm that there were 74 deaths caused by TRALI. Quite an alarming spike.
Increasing TRALI fatalities in the US and the lack of a clear definition called for action by the National Heart Lung and Blood Instit...
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...ates and RBC.
8. Toy P, Jun J, Hollis-Perry M, et al: Recipients of blood from a donor with multiple HLA antibodies: A blinded, lookback study of TRALI. Transfusion 2004; 44:1683–1688.
9. Covin, R.B., Ambruso, D.R., England, K.M., Kelher, M.R., Mehdizadehkashi, Z., Boshkov, L.K., Masuno, T., Moore, E.E., Kim, F.J. & Silliman, C.C. (2004) Hypotension and acute pulmonary insufficiency following transfusion of autologous red blood cells during surgery: a case report and review of the literature. Transfusion Medicine, 14, 375–383.
10. Rizk A, Gorson KC, Kenney L, Weinstein R.Transfusion-related acute lung injury after the infusion of IVIG. Transfusion. 2001; 41:264-268.
11. Chapman, C.E., Williamson, L.M., Cohen, H., Stainsby, D. & Jones, H. (2006) The impact of using male donor plasma on haemovigliance reports of transfusion related acute lung injury (TRALI) in the UK.
The prevalence of commotion cordis aids in the importance of this paper. Recently, the Minneapolis Heart Institute Foundation stated commotio cordis is one of the leading causes of sudden death in young athletes, only to be exceeded by hypertrophic cardiomyopathy and congential coronary artery abnormalities (Yabek, 2011). Over 250 instances have been reported to the US Commotio Cordis Registry since, there is most likely and underestimation of its true incidence since commotio cordis still continues to go unrecognized in many instances and therefore is underreported (Yabek, 2011).
Transcatheter aortic valve replacement or TAVR is the latest technology used principally for the treatment of aortic stenosis, a condition in which one of the major valves of the heart, the aortic valve, becomes tight and stiff, usually as a result of aging (3). Since many patients who need aortic valve replacement for aortic stenosis are too sick to undergo major valve replacement surgery, they are unable to get the treatment they need. With the transcatheter aortic valve, this issue is bypassed because this valve can be implanted in the heart by accessing the patient’s heart through an artery in the groin. The valve can be inserted through a wire that can be pushed to the heart and the old valve is simply pushed to the side when the new valve is implanted. This technology has been in use in the US with Edwards’ Sapiens valve since 2011 and has saved the lives of many patients with aortic stenosis (4). Medtronic’s CoreValve uses similar technology and has won patent fights in Europe and has been in use internationally. However, within U.S., Medtronic has not been...
Also, hypoxia, which is a lack of oxygen, is another pathological physiological outcome of sepsis as less oxygen is reaching the tissue; this is due to the fact that there is less oxygen in the blood.
Tzong-Jin, W., & Kuo-Inn, T. (1996). Transfusion-Related acute lung injury treated with surfactant in a neonate. European Journal of Pediatrics. 155. (7). 589-591.
Richards, G. A., & Joubert, I. (2013, July 2013). Extracorporeal Membrane Oxygenation (ECMO). South African Journal of Critical Care, 29(1), 7-9. http://dx.doi.org/10.7196/SAJCC.161
Epidemiology of VAP Hunter, Annadurai and Rothwell defines ventialtor-associated pneumonia as nosocomial pneumonia occurring in patients receiving more than 48 hours of mechanical ventilation via tracheal or trascheotomy tube. It is commonly classified as either early onset (occurring within 96 hours of start of mechanical ventilation) or late onset (>96 hours after start of mechanical ventilation. A ventilator is a machine that is used to help a patient breathe by giving oxygen through an endotracheal tube, which is a tube placed in a patient’s mouth or nose, or through a tracheostomy, which is a surgical opening created trough the trachea in front of the neck. Infection may occur if bacteria or virus enters the tube into the lungs or airways by manual manipulation of the ventilator tubing. Ventilator-associated pneumonia accounts for 80% of hospital-acquired pneumonia, 8-28% of incubate... ...
The Burden of the disease is high with a prevalence of 3.4% 2. With the progressive nature of the disease and the increased severity of the symptoms made the surgery the gold standard for symptomatic AS patients ,however up to 30% of cases are considered too high risk for classical valve replacement surgery and remain untreated and experiencing poor prognosis . Fortunately , with the introduction of TAVR its offer a valuable option for the inoperable or at high risk of surgery patients3..the annual eligible candidate for this procedure expected to be 27,000 in 19 European countries and North America according to recent meta-analysis an...
The American Heart Association gives sufficient evidence for the need of change by acknowledging that sudden cardiac arrest is a leading cause of death (2012). These fatalities affect both adult and child victims. Statistics also show that 70% of people feel helpless during a cardia...
Much of the blood needed for transfusions in Mississippi is shipped from nearby states as people in Mississippi do not usually donate enough to supply the demand for blood with in the state. The donated blood obviously goes to a multitude of patients in Mississippi; from people in car crashes, to cancer patients, to people sickle-cell disease, and many more.
Sepsis is defined as an exaggerated, overwhelming and uncontrolled systemic inflammatory response to an initially localised infection or tissue injury, which may lead to severe sepsis and septic shock if left untreated (Daniels, 2009; Robson & Daniels, 2013; Dellinger et al, 2013; Perman, Goyal & Gaieski, 2012; Vanzant & Schmelzer, 2011). Septic shock can be classified by acute circulatory failure as a result of massive vasodilation, increased capillary permeability and decreased vascular resistance in the body, causing refractory hypotension despite adequate fluid resuscitation. This leads to irreversible tissue ischaemia, end organ failure and ultimately, death (McClelland & Moxon, 2014; Sagy, Al-Qaqaa & Kim, 2013, Dellinger et al, 2013).
British Thoracic Society, (2008), Guideline for Emergency Oxygen Use in Adult Patients, Thorax: an International Journal of the Respiratory Medicine, 63 (6), DOI: 10.1136/thx.2008.102947
“Whoa-oa-oa! I feel good, I knew that I would now. I feel good….”. My “I feel good” ringtone woke me up from the depths of slumber during my first night call in internal medicine rotation. My supervising intern instructed me to come to the 4th floor for a patient in distress. Within moments, I scuttled through the hospital hallways and on to the stairs finally arriving short of breath at the nurses’ station. Mr. “Smith”, a 60 year old male with a past medical history of COPD was in respiratory distress. He had been bed bound for the past week due to his severe arthritis and had undergone a right knee replacement surgery the day before. During evening rounds earlier, he had no signs of distress. However, now at 2 AM in the morning, only hours later since rounds, he was minimally responsive. My intern and I quickly obtained the patient’s ABG measurements and subsequently initiated a trial of BIPAP. This resolved Mr. Smith’s respiratory distress and abnormal ABG values. To rule out serious causes of dyspnea, a stat chest x-ray and CT were obtained. Thankfully, both studies came back normal.
Sepsis is defined as a systemic inflammatory response caused by an infective process such as viral, bacterial or fungal (Holling, 2011). Assessment on a patient and starting treatment for sepsis is based on identifying several factors including the infective source, antibiotic administration and fluid replacement (Bailey, 2013). Because time is critical any delay in identifying patients with sepsis will have a negatively affect the patients’ outcome. Many studies have concluded every hour in delay of treatment mortality is increased by 7% (Bailey, 2013). Within this assignment I will briefly discuss the previous practice and the recent practice including the study based on sepsis. I will show what enabled practice to change and I will use the two comparisons of current practice and best practice.
Transfusions of red blood cells, platelets, and plasma are critical to a patient's return to good health,
Over two thirds of deaths in each year among estimated yearly deaths are due to non-communicable diseases such as cardiovascular disease, hypertension, diabetics, cancer and upper res...