This is a single center retrospective case control study of 7 Transfusion Related Acute Lung Injury (TRALI) cases and 28 controls in the pediatric spinal surgery population.
To determine the association between maternal transfusion and risk of TRALI in pediatric spinal surgery patients.
Summary of Background Data
Previous studies support a “two-hit” model for the pathogenesis of TRALI – activation and sequestration of neutrophils in the pulmonary vasculature followed by transfusion of a biologic response modifier such as anti-leukocyte antibodies. Maternal donation of blood products is a potential risk factor for TRALI due to the development of anti-leukocyte antibodies during pregnancy. Until now there have been no studies specifically addressing the risk of TRALI following maternal transfusions.
This is a retrospective case control study of 7 TRALI cases with 4 controls per case, matched by strata for volume of plasma transfused. All cases identified by the Transfusion Biology and Medicine Specialized Center of Clinically Oriented Research (SCCOR) with a TRALI diagnosis were eligible for inclusion. Electronic medical records and operative notes were reviewed to obtain demographic data, diagnosis, surgical approach and number of spine levels for each operation.
An increased prevalence of maternal blood transfusion was found among the TRALI cases compared to the control cases: 43% (3 of 7) versus 7% (2 of 28), p = 0.044. There were otherwise no statistical differences between the groups, including age, gender, surgical approach, number of spinal levels, or type of blood product transfused.
Pediatric patients undergoing spinal surgery may be at increased risk for the development of TRALI following the transfusion of maternal blood products. Accordingly, we recommend that directed donation of maternal blood products should be avoided in this population. This study also found that TRALI may be under-recognized and under-reported to the transfusion service.