TRALI And Foreign Body in The Trachea: As a Cause Of Acute Dyspnea in The Same Patient

Year 2018, Volume: 10 Issue: 1, 45 - 48, 01.04.2018

Şeyma Başlılar Bengü Şaylan Nesrin Sarıman

Abstract

Dyspnea is one of the most frequent symptomps in pulmonology practice. Pulmonary consultance is frequently demanded for both in-patients and patients in emergency room with acute dyspnea. Foreign bodies in trachea and bronchi may be skipped easily in patients who applied emergency room with acute dyspnea denying history of aspiration, Transfusion related acute lung injury TRALI is a condition of pulmonary edema developes following transfusion and results in acute respiratory dystress. As it is a rare condition misdiagnosis is probable. 44 years old male developed acute and severe respiratory dystress following transfusion applied for perirenal hematoma and intubated in intensive care unit. He recovered fast clinically and radiologically, so he was discharged from hospital 2 days after extubation. But in a few days he applied emergency service with a compliant of acute dyspnea again. The foreign body in trachea was skipped in radiological examinations, Finally he self-expectorated the piece of intubation tube by coughing and dyspnea was resolved.

Keywords

dyspnea, foreign body, TRALI

Aynı Olguda İki Nadir Akut Dispne Nedeni: TRALI ve Trakeada Yabancı Cisim

Abstract

Nefes darlığı, göğüs hastalıkları pratiğinde en sık karşılaşılan semptomlardan biridir. Yatarak takip edilen ve acile başvuran olgularda akut dispne nedeni ile sıklıkla konsültasyon istenmektedir. Acil polikliniğe solunum sıkıntısı ile başvuran olgu aspirasyon öyküsü tariflemiyorsa, trakea ve bronşta yabancı cisim varlığı gözden kaçabilir. Transfusion related acute lung injury TRALI transfüzyon sonrası gelişen akut solunum sıkıntısına neden olan akciğer ödemi tablosudur. Bu patoloji de nadir görülmesi nedeni ile ilk sırada akla gelmeyebilir. 44 yaşında erkek hasta, perirenal hematom nedeni ile yapılan kan transfüzyonu sonrasında ani ve ciddi solunum sıkıntısı gelişmesi üzerine yoğun bakım ünitesine alınarak entübe edilmiş, klinik ve radyolojik olarak hızla düzelen hasta ekstübasyondan iki gün sonra taburcu edilmiş, ancak acil polikliniğe tekrar nefes darlığı ile başvurmuştur. Trakea içinde entübasyon tüpünün parçası tetkiklerde gözden kaçmış, hasta öksürerek “self ekspektorasyon” ile yabancı cismi çıkardıktan sonra nefes darlığı düzelmiştir.

Keywords

dispne, yabancı cisim, TRALI

References

• Popovsky MA, Moore SB. Diagnostic and pathogenetic considerations in transfusion-related acute lung injury. Transfusion.1985;25:573-577.
• Holness L, Knippen MA, Simmons L, Lachenbruch PA. Fatalities caused by TRALI. Transfus Med Rev. ;18:184-188. Álvarez P, Carrasco R , Dapueto CR, Castillo R.L. Transfusion-Related Acute Lung Injury (TRALI): Current Concepts . The Open Respiratory Medicine Journal.2015,9,(Suppl 2:M3).92-96.
• Kim J, Na S.Transfusion-related acute lung injury; clinical perspectives. Korean Journal of Anesthesiology. Vol 68 No 2.2015:101-105.
• Clifford L, Jia Q, Subramanian A,Yadav H, Wilson GA,Murphy SP. Characterizing the Epidemiology of Postoperative Transfusion related Acute Lung Injury. Anesthesiology 2015 January;122(1):12-20.
• Toy P, Popovsky MA, Abraham E, et al. Transfusion- related acute lung injury: Definition and review.Crit Care Med.2005;33:721-726 .
• Beck TN, Young NG, Erickson ML,Prats I. Rare antibody-associated hemolytic transfusion reaction and transfusion-related acute lung injury: a case report. BMC surgery;(2017) 17:48.
• Pandee U,Tanpowpong P, Thongpo P. A Teenage Girl with Acute Dyspnea and Hypoxemia during Red Blood Cell Transfusion. Case Reports in Pediatrics. Volume ; 201: 9372678
• Jawaski K,Maslanka K,Jakimiuk et al.Transfusion- related acute lung injury in a young woman with ectopic pregnancy–case report and literature review. Ginekol Pol. 2016,87,231-234.
• Basat S, Serin S, Aksakal B, Yiğit E. Gözden Kaçan Bir Tanı; Transfüzyona Bağlı Akut Akciğer Hasarı: Olgu Sunumu.ŞEEAH Tıp Bülteni 2014;48: 248-253.
• Kaya Y, Çanakçı E, Taş N, Akgedik R. Trombosit Transfüzyonuna Bağlı Gelişen Akut Akciğer Hasarı Olgusu. ODÜ Tıp Dergisi Ek:9-11. 2016: 25-27.
• Looney MR, Gropper MA, Matthay MA. Transfusion-related acute lung injury -a review. Chest.2004,126(1):249-258.
• Kopko PM, Popovsky MA, MacKenzie MR, et al. HLA class II antibodies in transfusion-related acute lung injury. Transfusion.2001;41:1244–1248.
• Kopko PM, Paglieroni TG, Popovsky MA, et al. TRALI: correlation of antigen-antibody and monocyte activation in donor-recipient pairs. Transfusion.2003; :177-184.
• Sachs UJ, Hattar K, Weissmann N, et al. Antibody- induced neutrophil activation as a trigger for transfusion-related acute lung injury in an ex vivo rat lung model. Blood.2006;107:1217-1219.
• Silliman CC, Curtis BR, Kopko PM, et al. Donor antibodies to HNA-3a implicated in TRALI reactions prime neutrophils and cause PMN-mediated damage to human pulmonary microvascular endothelial cells in a two-event, in vitro model. Blood. 2007; 109:1752- 17.Silliman CC, Elzi DJ, Ambruso DR, et al.
• Lysophosphatidylcholines prime the NADPH oxidase and stimulate multiple neutrophil functions through changes in cytosolic calcium.J Leukoc Biol.2003;73:511
• Haji AG, Sharma S, Vijaykumar DK, Paul J. Transfusion related acute lung injury presenting with acute dyspnea: a case report. Journal of medical case reports 2008; 2:336 (1-6).
• Wyman TH, Bjornsen AJ, Elzi DJ, et al. A two- insult in vitro model of PMN mediated pulmonary endothelial damage requirements for adherence and chemokine release.Am J Physiol Cell Physiol.2002,283: C1592-C1603.
• Özdemir C, Sökücü SN, Karasulu L, Büyükkale S, Dalar L. Erişkinde yabancı cisim aspirasyonu : 28 olgunun analizi. Eurasian J Pulmonol 2015; 17: 29-34