Indian J Pediatr (October 2012) 79(10):1363–1365 DOI 10.1007/s12098-011-0668-6
CLINICAL BRIEF
Transfusion Related Acute Lung Injury in a Neonate Shuchita Gupta & Tapas Som & Lakshmi Iyer & Ramesh Agarwal
Received: 16 June 2011 / Accepted: 16 December 2011 / Published online: 29 December 2011 # Dr. K C Chaudhuri Foundation 2011
Abstract Transfusion related acute lung injury (TRALI) is a life threatening and potentially fatal complication of blood component transfusion, which largely remains under- diagnosed and under-reported, especially in neonates. The present case aims to emphasize that TRALI should be kept as a differential diagnosis in all groups of patients, including neonates, who develop acute respiratory distress and fresh lung infiltrations in the chest radiograph within 6 h of blood component transfusion in the absence of evidence of volume overload or cardiac dysfunction. Its recognition is important in view of the associated illness and death, for instituting correct management, and for eliminating implicated donors from donor panels. Keywords Transfusion related acute lung injury . Neonate
Case Report A single, male baby was born to a 26-y-old primigravida mother at 27 completed wk of gestation by spontaneous vaginal delivery, with a birth weight of 847 g. She received two doses of betamethasone 7 d prior to labor. The baby was limp at birth and required bag and tube ventilation, with Apgar scores of 4 and 7 at 1 and 5 min respectively. He received prophylactic surfactant and started on mechanical ventilation. Serial ECHOs done in the first wk of life were normal, with no evidence of persistent ductus arteriosus or any other cardiac lesion. On day five, baby S. Gupta : T. Som : L. Iyer : R. Agarwal (*) Newborn Health Knowledge Center (NHKC), Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India e-mail:
[email protected]
developed culture positive bacterial sepsis with pneumonia and meningitis. Chest skiagram showed bilateral infiltrates. He received intravenous antibiotics for 21 d. The chest skiagram cleared (Fig. 1a), baby was extubated on day 14 of life and was on non-invasive ventilation (CPAP/IPPV) till day 40 of life. The baby received packed red blood cell (PRBC) transfusions on day 4, 5, 16 and 18 of life. Last PRBC transfusion was given for anemia (PCV
