A 29-year-old woman on oral contraceptives presents with abdominal pain. A computed tomography (CT) scan of the abdomen demonstrates a large hematoma of the right liver with the suggestion of an underlying liver lesion. Her hemoglobin is 6, and she is transfused 2 units of packed red blood cells and 2 units of fresh frozen plasma. Two hours after staing the transfusion, she develops respiratory distress and requires intubation. She is not volume overloaded clinically, but her chest x-ray shows bilateral pulmonary infiltrates. Which of the following is the management strategy of choice?
The patient has TRALI or transfusion-related acute lung injury which manifests as respiratory distress, hypoxemia, and bilateral pulmonary infiltrates not due to volume overload. The treatment of choice is respiratory suppo, including mechanical ventilation, as needed. The major risk factor for TRALI is transfusion of any plasma-containing blood products from multiparous female donors. Other complications of transfusions and their treatments include: (1) allergic reactions such as rash and fever--mild reactions are treated with an antihistamine; (2) transfusion-associated circulation overload (TACO) which occurs in patients with underlying hea failure who receive large volume transfusions--the treatment is administration of diuretics; and hemolytic reactions--diagnosis is made by a positive Coombs test and treatment is to stop the transfusion and identify the responsible antigen to prevent future reactions. There is no evidence that the patient has pneumonia or any other indication to perform bronchoscopy or to sta antibiotics.
Continue the transfusion and administer an antihistamine
Stop the transfusion and administer a diuretic
Stop the transfusion, perform bronchoscopy, and sta broad-spectrum empiric antibiotics
Stop the transfusion and continue suppoive respiratory care
Miscellaneous