Canadian Journal of Anesthesia

, 50:895

Transfusion-related acute lung injury or acute chest syndrome of sickle cell disease? — A case report

  • Paul G. Firth
  • Yoshihiko Tsuruta
  • Yogish Kamath
  • Walter H. Dzik
  • Christopher S. Ogilvy
  • Robert A. Peterfreund
General Anesthesia



To describe how to differentiate transfusion-related acute lung injury from acute chest syndrome of sickle cell disease.

Clinical features

A neurosurgical patient with sickle cell disease received two units of packed red blood cells postoperatively. Four hours later she developed progressive respiratory distress, diffuse geographical airspace disease and bilateral pulmonary edema. The patient recovered sufficiently to be transferred from the intensive care unit within four days. The temporal relationship to transfusion, features on computerized tomographic scan, and the rapid resolution of severe edema point to a diagnosis of transfusion related acute lung injury. Granulocyte or human leukocyte antigen antibodies in donor plasma may confirm a diagnosis of transfusion injury.


The clinician should appreciate that erythrocyte transfusion to prevent or treat acute chest syndrome may cause transfusion related acute lung injury, a condition that mimics, exacerbates or possibly triggers the syndrome it was intended to treat.

Une étude de cas : lésion pulmonaire aiguë post-transfusionnelle ou syndrome pulmonaire aigu de la drépanocytose ?



Décrire comment distinguer la lésion pulmonaire aiguë posttransfusionnelle et le syndrome pulmonaire aigu de ia drépanocytose

Éléments cliniques

Une patiente de neurochirurgie atteinte de drépanocytose a reçu deux unités de globules rouges concentrés après l’intervention chirurgicale. Quatre heures plus tard, une détresse respiratoire, des lésions microalvéolaires diffuses et un œdème pulmonaire bilatéral se sont développés. La patiente, suffisamment remise, a pu quitter l’unité des soins intensifs en moins de quatre jours. La relation temporelle avec la transfusion, les caractéristiques de l’examen tomographique et la résolution rapide de l’œdème sévère vont dans le sens d’un diagnostic de lésion pulmonaire aiguë post-transfusionnelle. La présence, dans le sang du donneur, d’anticorps antigranulocytes ou antileucocytes humains peut confrmer un diagnostic de lésion post-transfusionnelle.


Il faut savoir que la transfusion d’érythrocytes visant à prévenir ou à traiter un syndrome pulmonaire aigu peut causer une lésion pulmonaire post-transfusionnelle, un état qui imite, exacerbe ou déclenche possiblement le syndrome qu’il voulait traiter.


  1. 1.
    Vichinsky EP, Neumayr LD, Earles AN, et al. Causes and outcomes of the acute chest syndrome in sickle cell disease. National Acute Chest Syndrome Study Group. N Engl J Med 2000; 342: 1855–65.PubMedCrossRefGoogle Scholar
  2. 2.
    Popovsky MA, Moore SB. Diagnostic and pathogenetic considerations in transfusion-related acute lung injury. Transfusion 1985; 25: 573–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Popovsky MA, Davenport RD. Transfusion-related acute lung injury: femme fatale? (Editorial). Transfusion 2001; 41: 312–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Silliman CS. Transfusion-related acute lung injury. Transfus Med Rev 1999; 13: 177–86.PubMedCrossRefGoogle Scholar
  5. 5.
    Ward HN. Pulmonary infiltrates associated with leukoagglutinin transfusion reactions. Ann Intern Med 1970; 73: 689–94.PubMedGoogle Scholar
  6. 6.
    Cox JV, Steane E, Cunningham G, Frenkel EP. Risk of alloimmunization and delayed hemolytic transfusion reactions in patients with sickle cell disease. Arch Intern Med 1988; 148: 2485–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Petz LD, Tarn P, Wilkinson L, Garratty G, Lubin B, Mentzer W. Increased IgG molecules bound to the surface of red blood cells of patients with sickle cell anemia. Blood 1984; 64: 301–4.PubMedGoogle Scholar
  8. 8.
    Castellino SM, Combs MR, Zimmerman SA, Issitt PD, Ware RE. Erythrocyte autoantibodies in paediatric patients with sickle cell disease receiving transfusion therapy: frequency, characteristics and significance. Br J Hematol 1999; 104: 189–94.CrossRefGoogle Scholar
  9. 9.
    Lard LR, Mul FP, de Haas M, Roos D, Duits AJ. Neutrophil activation in sickle cell disease. J Leukoc Biol 1999; 66: 411–5.PubMedGoogle Scholar
  10. 10.
    Hebbel RP, Vercellotti GM. The endothelial biology of sickle cell disease. J Lab Clin Med 1997; 129: 288–93.PubMedCrossRefGoogle Scholar
  11. 11.
    Hsu L, McDermott T, Brown L, Aguayo SM. Transgenic HbS mouse neutrophils in increased susceptibility to acute lung injury. Implications for sickle acute chest syndrome. Chest 1999; 116(2 Suppl): 92S.PubMedCrossRefGoogle Scholar
  12. 12.
    Esseltine DW, Baxter MR, Bevan JC. Sickle cell states and the anaesthetist. Can J Anaesth 1988; 35: 385–403.PubMedCrossRefGoogle Scholar
  13. 13.
    Entre U, Miller ST, Gutrierez M, Steiner P, Rao SP, Rao M. Effect of transfusion in acute chest syndrome of sickle cell disease. J Pediatr 1995; 127: 901–4.CrossRefGoogle Scholar
  14. 14.
    Mallouh AA, Asha M. Beneficial effects of blood transfusion in children with sickle cell chest syndrome. Am J Dis Child 1988; 142: 178–82.PubMedGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2003

Authors and Affiliations

  • Paul G. Firth
    • 1
  • Yoshihiko Tsuruta
    • 1
  • Yogish Kamath
    • 2
  • Walter H. Dzik
    • 3
  • Christopher S. Ogilvy
    • 2
  • Robert A. Peterfreund
    • 1
  1. 1.Department of Anesthesia and Critical CareHarvard Medical School, Massachusetts General HospitalBostonUSA
  2. 2.Department of NeurosurgeryHarvard Medical School, Massachusetts General HospitalBostonUSA
  3. 3.Department of Blood Transfusion ServiceHarvard Medical School, Massachusetts General HospitalBostonUSA
  4. 4.Nuffield Department of AnaestheticsRadcliffe InfirmaryOxfordUK

Personalised recommendations