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Résumé: Les complications respiratoires de la transfusion sanguine ont plusieurs étiologies possibles. Le diagnostic de Transfusion-Associated Circulatory Overload (TACO) est souvent le premier évoqué, celui de Transfusion-Related Acute Lung Injury (TRALI), mieux défini depuis la conférence de Toronto de 2004, l’est plus rarement. Son incidence selon les données épidémiologiques françaises est faible. Des réactions fébriles non hémolytiques, des allergies, des infections et des embolies pulmonaires sont également rapportées. L’objectif de notre travail a été de déterminer l’importance épidémiologique des différentes complications de type respiratoire d’une transfusion sanguine. Ce travail a été mené de façon rétrospective sur les accidents transfusionnels survenus dans 6 centres de santé de la région Champagne-Ardenne, déclarés à l’hémovigilance entre 2000 et 2009 et comportant une symptomatologie respiratoire. L’analyse des dossiers a été réalisée par un collège d’experts. Sur les 83 dossiers de complications respiratoires retrouvés (316864 produits sanguins administrés), 26 étaient des TACO, 12 des TRALI (seulement 6 cas étaient identifiés par l’enquête initiale d’hémovigilance), 18 des réactions fébriles non hémolytiques, 16 des cas d’allergie, 5 des infections bactériennes transmises par la transfusion et 2 des embolies pulmonaires. Les 6 nouveaux TRALI diagnostiqués étaient préalablement étiquetés TACO pour 2 d’entre eux, allergie et infection pour 2 autres cas et le diagnostic considéré comme inconnu pour les 2 derniers. Notre étude a retrouvé une incidence des cas de TRALI 2 fois plus importante que celle déclarée auparavant. L’interprétation des données par un comité multidisciplinaire modifie 20 % des diagnostics. Cette étude montre des imperfections de notre système de notification des accidents de la transfusion sanguine quand un observateur médical unique analyse les dossiers. [ABSTRACT FROM AUTHOR]

Abstract: “Transfusion-related acute lung injury” (TRALI) is a post-transfusion lesional pulmonary edema, potentially severe, better defined since the conference of Toronto in 2004. The incidence of TRALI reported in France remains low in part because of its ignorance by physicians. The objective of our study was to evaluate retrospectively transfusion accidents with respiratory complications that occurred in Nancy University Hospital and reported to the haemovigilance between 1996 and 2006, from the software “Traceline” listing all the blood transfusion complications from signs observed. The analysis of the files has been performed by applying rigorously diagnostic criteria of Toronto. Forty-one cases of respiratory complications were found in 34,573 blood products. Ten cases of TRALI were diagnosed while only one case had been reported to the haemovigilance. The remaining nine cases were previously labeled transfusion-associated circulatory overload (TACO). No cases of TRALI have been identified in the ICU. Our work can find an incidence of TRALI 10 times greater than previously reported. Ignorance of TRALI and the lack of consensus definition before 2004 are not sufficient to explain these results. This study demonstrates the potential interest of database and computerized declaration system based on the symptoms observed. It highlights the vulnerability of the current haemovigilance too dependent on a single medical observer. Although TRALI are recognized as serious complications, sometimes requiring resuscitative care, our work was not isolated severe TRALI in ICU. Physician awareness of TRALI to the identification and to the declaration, including ICU should be continued. Finally, the diagnostic criteria for TRALI must be adapted to the ICU. [Copyright &y& Elsevier]

Abstract: Pulmonary oedema after transfusion of blood products may be hydrostatic (transfusion-associated circulatory overload [taco]) or exsudative (transfusion-related acute lung injury [trali]). Both conditions have been recognized as major hazards to transfusion recipients. Risk characterization is necessary to improve safety and to monitor trends in the national blood transfusion system. A collaborative multidisciplinary working group of the French National Hemovigilance Committee has proposed an analysis framework for case definitions and classification. The method relies on internationally used definitions and is adapted to the codification procedures used in the french transfusion incident reports electronic data management. [ABSTRACT FROM AUTHOR]

Abstract: Pulmonary oedemas occurring during or after a blood transfusion appear as the most frequent serious immediate incidents in the French hemovigilance database. They include transfusion-associated circulatory overload (TACO) and transfusion-related acute lung injury (TRALI). TACO are a major cause of transfusion-related death in France. TRALI are more and more recognized and notified. In no case, pooled fresh frozen plasma (100 donations) treated with solvent–detergent were involved in French TRALI cases. A logigrame will allow hemovigilance officers to better classify pulmonary oedemas in e-fit, the French hemovigilance database. [Copyright &y& Elsevier]

Respiratory complications of blood transfusion have several possible causes. Transfusion-Associated Circulatory Overload (TACO) is often the first mentioned. Transfusion-Related Acute Lung Injury (TRALI), better defined since the consensus conference of Toronto in 2004, is rarely mentioned. French incidence is low. Non-hemolytic febrile reactions, allergies, infections and pulmonary embolism are also reported. The objective of this work was to determine the statistical importance of the different respiratory complications of blood transfusion. This work was conducted retrospectively on transfusion accidents in six health centers in Champagne-Ardenne, reported to Hemovigilance between 2000 and 2009 and having respiratory symptoms. The analysis of data was conducted by an expert committee. Eighty-three cases of respiratory complications are found (316,864 blood products). We have counted 26 TACO, 12 TRALI (only 6 cases were identified in the original investigation of Hemovigilance), 18 non-hemolytic febrile reactions, 16 cases of allergies, 5 transfusions transmitted bacterial infections and 2 pulmonary embolisms. Six new TRALI were diagnosed previously labeled TACO for 2 of them, allergy and infection in 2 other cases and diagnosis considered unknown for the last 2. Our study found an incidence of TRALI 2 times higher than that reported previously. Interpretation of the data by a multidisciplinary committee amended 20% of diagnoses. This study shows the imperfections of our system for reporting accidents of blood transfusion when a single observer analyses the medical records., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)