Intensive Care Medicine

, Volume 36, Issue 10, pp 1710–1717 | Cite as

Transfusion-related acute lung injury in ICU patients admitted with gastrointestinal bleeding

  • Alexander B. BensonEmail author
  • Gregory L. Austin
  • Mary Berg
  • Kim K. McFann
  • Sila Thomas
  • Gina Ramirez
  • Hugo Rosen
  • Christopher C. Silliman
  • Marc Moss



Transfusion of blood components is common in patients admitted to the intensive care unit (ICU) for gastrointestinal (GI) bleeding, yet the incidence and risk factors for development of transfusion-related acute lung injury (TRALI) in these patients are unknown.


Patients admitted to a medical ICU for GI bleeding (n = 225) were analyzed for patient- and transfusion-specific risk factors for development of TRALI.


In transfused patients (n = 150), the incidence of TRALI was 15% [95% confidence interval (CI), 10–21%] and accounted for 76% (22/29) of all acute lung injury (ALI) cases. Transfused patients with end-stage liver disease (ESLD) (n = 72) developed TRALI more frequently than those without ESLD (29% versus 1%, p < 0.01). Fresh frozen plasma (FFP) was temporally associated with TRALI in 86% of cases. Transfusion-specific risk factors for development of TRALI included number of transfused units of FFP and nonleukoreduced red blood cells. Patient-specific risk factors included Model for End-Stage Liver Disease (MELD) score, admission serum albumin level, and presence of ALI risk factors.


TRALI is common in critically ill ESLD patients with gastrointestinal bleeding. Nonleukoreduced red blood cells and FFP are significant transfusion-specific risk factors and their use should be re-evaluated in bleeding patients with ESLD.


Transfusion-related acute lung injury Transfusion complications Acute respiratory distress syndrome Variceal bleeding Chronic liver disease Plasma transfusion 



National Heart, Lung and Blood Institute, National Institute of Health; K24 HLO89223. National Institute of General Medical Sciences, National Institute of Health; Grant GM49222. American Gastroenterological Association Research Scholar Award.

Supplementary material

134_2010_1954_MOESM1_ESM.doc (24 kb)
Supplementary material 1 (DOC 24 kb)


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Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Alexander B. Benson
    • 1
    Email author
  • Gregory L. Austin
    • 2
  • Mary Berg
    • 3
  • Kim K. McFann
    • 4
  • Sila Thomas
    • 5
  • Gina Ramirez
    • 5
  • Hugo Rosen
    • 2
  • Christopher C. Silliman
    • 5
  • Marc Moss
    • 1
  1. 1.Division of Pulmonary Sciences and Critical CareUniversity of Colorado DenverAuroraUSA
  2. 2.Division of Gastroenterology and HepatologyUniversity of Colorado DenverAuroraUSA
  3. 3.Department of PathologyUniversity of Colorado DenverAuroraUSA
  4. 4.School of Public HealthUniversity of Colorado DenverAuroraUSA
  5. 5.Bonfils Blood CenterDenverUSA

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