Mary Posted July 19, 2007 Share Posted July 19, 2007 I would be interested to hear what some of you are including in your investigations of reactions to plasma products to differentiate a TRALI reaction from other reactions. Link to comment Share on other sites More sharing options...
rcurrie Posted July 20, 2007 Share Posted July 20, 2007 Patient history (underlying disease, transfusion history), chest x-ray to look for bilateral infiltrates (whiteout on film), HLA antibody screen. The first questions I ask are: Did the patient have multiple units of blood components transfused in the last 24 hours and, if so, how close together; does the patient have an underlying respiratory condition, congestive heart failure, or renal disease; and did Lasix resolve the symptoms (nurses always give Lasix) (to rule out TACO). A Yes answer to any of the questions above points toward TACO, and we will not reflex the HLA antibody screen. I also check my donor history to see if in the past they have been implicated in a transfusion reaction with respiratory distress. This is easy for me because we have our own donor center and all our transfusions come from our own donors. If your blood is supplied from somewhere else, it will be like pulling unanesthetized tiger teeth to get this info.BC Link to comment Share on other sites More sharing options...
Mary Posted July 20, 2007 Author Share Posted July 20, 2007 Thanks. That is helpful. I will have to tackle that tiger! Link to comment Share on other sites More sharing options...
JMunden Posted July 20, 2007 Share Posted July 20, 2007 "Guilt by Association" and implications as described by RC...we also perform a BNP which will be elevated with TACO, but one has to remember the status of the patient-could be a heart patient with congestive heart failure and TRALI...etc. Link to comment Share on other sites More sharing options...
Mabel Adams Posted July 21, 2007 Share Posted July 21, 2007 Would pre and post BNPs be useful? Link to comment Share on other sites More sharing options...
rcurrie Posted July 21, 2007 Share Posted July 21, 2007 Expensive, to say the least. I don't see the value of running a pre-transfusion BNP. There is a range that indicates congestive heart failure. A baseline isn't necessary. Whenever my medical brigade was deployed for Operation Katrina, I ran BNPs to help rule out myocardial infarction. We saw about 900 patients a day for 14 days, all from the Superdome group. We had several MIs, but we were able to rule out MI in many cases using the BNP as part of a cardiac profile. The lab (and field hospital) was in an underground parking garage with no running water. Makeshift is an understatement. I have attached a picture of my test menu. A lot of the doctors had legal questions, so I added some things to the test menu to cover the majority of questions I was asked. ;-)I am deploying to the Mexican border this Sunday for a medical mission. I have been down there before, and it is interesting.BC Link to comment Share on other sites More sharing options...
bbbirder Posted July 21, 2007 Share Posted July 21, 2007 Bob,I hope you will have internet access where you are going south of the border, I'd hate to be without your posts!Linda Frederick Link to comment Share on other sites More sharing options...
rcurrie Posted July 22, 2007 Share Posted July 22, 2007 Thanks, Linda, but this is my last post until I return in 7 days. It is a short mission, but it will be an intense week. We will work 18 hour days, and there will be no access to the Internet. I won't even know where I will be going until I get there. I will report to the National Guard armory in Weslaco, and then be deployed from there. It will definitely be extremely rural, though. I do know that.BC Link to comment Share on other sites More sharing options...
Mabel Adams Posted July 25, 2007 Share Posted July 25, 2007 I tought if a post BNP was high a pre- might help determine if it was underlying heart disease or not. Link to comment Share on other sites More sharing options...
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