Incidence of transfusion-related acute lung injury temporally associated with solvent/detergent plasma use in the ICU

Background: Transfusion-related acute lung injury (TRALI) is a severe complication of plasma transfusion, though use of solvent/detergent pooled plasma (SDP) has nearly eliminated reported TRALI cases. The goal of this study was to investigate TRALI incidence in the intensive care unit (ICU) following replacement of quarantined, male-only, fresh frozen plasma (qFFP) by SDP for routine use. Methods:We conducted a retrospective multicenter observational before-after cohort study during two six-month periods, before (April to October 2014) and after introduction of SDP (April to October 2015), taking into account a six-month wash-out period. One secondary and four tertiary academic hospitals participated.Results:Admitted to the ICU were 8944 patients during both inclusion periods. 1171 qFFP units were transfused in 376 patients in the qFFP, and 396 during the before and after periods respectively in the SDP period. A full patient chart review was performed in 300 patients that received ≥1 units of plasma and had a PaO2/FiO2-ratio (P/F-ratio) Conclusion:Implementation of SDP lowered the incidence of TRALI in which plasma products were implicated, though not significantly. TRALI can still occur as a result of SDP transfusion. Developing TRALI in the ICU was associated with high mortality rates, therefore clinicians should remain vigilant.