Acute lung injury after ruptured abdominal aortic aneurysm repair: The effect of excluding donations from females from the production of fresh frozen plasma

OBJECTIVES:Transfusion-related acute lung injury may contribute to the development of acute lung injury in the critically ill, due to plasma from female donors containing antileukocyte antibodies. In July 2003, the U.K. National Blood Service stopped using female donor plasma for the production of f...

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Published in:	Critical care medicine Vol. 36; no. 6; pp. 1796 - 1802
Main Authors:	Wright, Stephen E, Snowden, Christopher P, Athey, Sally C, Leaver, Alice A, Clarkson, Jill-Marie, Chapman, Catherine E, Roberts, David R. D, Wallis, Jonathan P
Format:	Journal Article
Language:	English
Published:	Hagerstown, MD by the Society of Critical Care Medicine and Lippincott Williams & Wilkins 01-06-2008 Lippincott
Subjects:	Aged Aged, 80 and over Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Aneurysm, Ruptured - blood Aneurysm, Ruptured - mortality Aneurysm, Ruptured - surgery Aortic Aneurysm, Abdominal - blood Aortic Aneurysm, Abdominal - mortality Aortic Aneurysm, Abdominal - surgery Biological and medical sciences Blood Component Transfusion - adverse effects Blood Donors Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis Critical Care Endothelium, Vascular - immunology Female Hospital Mortality Humans Intensive care medicine Isoantibodies - blood Male Medical sciences Plasma Postoperative Complications - blood Postoperative Complications - etiology Postoperative Complications - mortality Postoperative Complications - prevention & control Prospective Studies Respiratory Distress Syndrome, Adult - blood Respiratory Distress Syndrome, Adult - etiology Respiratory Distress Syndrome, Adult - mortality Respiratory Distress Syndrome, Adult - prevention & control Risk Factors Transfusions. Complications. Transfusion reactions. Cell and gene therapy Women Lung disease blood transfusion Intensive care Transfusion Respiratory disease Fresh frozen plasma Cardiovascular disease Aortic aneurysm acute lung injury ruptured acute respiratory distress syndrome Respiratory distress abdominal Resuscitation
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Summary:	OBJECTIVES:Transfusion-related acute lung injury may contribute to the development of acute lung injury in the critically ill, due to plasma from female donors containing antileukocyte antibodies. In July 2003, the U.K. National Blood Service stopped using female donor plasma for the production of fresh frozen plasma. Patients undergoing repair of a ruptured abdominal aortic aneurysm receive large amounts of fresh frozen plasma and often develop acute lung injury. We investigated whether the change to male fresh frozen plasma was associated with a change in the frequency of acute lung injury in these patients. DESIGN:A retrospective, before and after, observational, single-center study. SETTING:Tertiary care center and a regional blood center. PATIENTS:The study included 211 patients undergoing open repair of a ruptured abdominal aortic aneurysm between 1998 and 2006. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Primary outcome was the development of acute lung injury in the first 6 hrs after surgery. Secondary outcomes were significant hypoxia (Pao2/Fio2 ratio <300), time to extubation, and survival at 30 days. Groups were well matched and received similar volumes of intravenous fluids and blood components. There was significantly less acute lung injury following the change to male fresh frozen plasma (36% before vs. 21% after, p = .04). At 6 hrs after surgery, fewer patients were hypoxic (87% before vs. 62% after, p < .01). In multivariate analysis, the change in donor policy was associated with a decreased risk of developing acute lung injury (odds ratio 0.39; 95% confidence interval, 0.16–0.90). Time to extubation and survival at 30 days were not statistically different between groups. CONCLUSIONS:The policy to exclude female donors from the production of fresh frozen plasma was associated with a decrease in the frequency of acute lung injury in patients undergoing repair of a ruptured abdominal aortic aneurysm.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0090-3493 1530-0293
DOI:	10.1097/CCM.0b013e3181743c6e