• Alexander B Benson, Gregory L Austin, Mary Berg, Kim K McFann, Sila Thomas, Gina Ramirez, Hugo Rosen, Christopher C Silliman, and Marc Moss.
• Division of Pulmonary Sciences and Critical Care, University of Colorado Denver, Anschutz Medical Campus Research 2, Box C272, 9th floor, 12770 East 19th Ave., Aurora, CO, 80045, USA. Alexander.benson@ucdenver.edu.
• Intensive Care Med. 2010 Oct 1; 36 (10): 1710-1717.

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

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