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Tuesday, September 15, 2009

TRALI – Prevention

Prevention Strategies:

1. The best way to prevent TRALI is by limiting the amount of transfused products and rethinking the need for and efficacy thereof of transfusion.

Triggers for transfusion of blood and blood products should be raised. SHOT strongly advises against unnecessary blood product transfusion.

2. Screening blood products for white cell antibodies.

The prevalence of HLA antibodies in the donor pool ranges from 8% to 22%, but the prevalence of neutrophil-specific antibodies is not known. If these antibodies are found in the donor, it is still debated whether these donors should be deferred from donation, their blood should only be used for low plasma volume products, or no intervention taken.

3. Debate on the prevention of TRALI often centers on the female donor, especially the multiparous donor. Parity is especially associated with increased antibody prevalence, and the majority of donors associated with TRALI are multiparous
females.

In late 2006, the American Association of Blood Banks (AABB),made several recommendations to reduce the frequency
of TRALI, including moving toward the use of high plasma volume containing products that are donated only by men.

4. Leukoreduction; it is currently employed by several Western countries. However, the various methods of leukoreduction have drawbacks. For example, although washing may also reduce biologically active substances, it decreases blood product quantity and shelf-life.

5. As aging RBCs accumulate both lipid mediators and leukocyte-derived substances, an argument can also be made for using fresher RBCs, when possible, to minimize the immune consequences of transfusion.

6. Finally, with regards to the management of a donor involved in a TRALI reaction, the AABB provides a series of guidelines, including deferring the donor from all donations, deferral of donation from high plasma volume containing products only, washing donor RBCs, and plasma fractionation.

Ref : Journal of Intensive Care Medicine / Vol. 23, No. 2, March/April 2008

Click here to read about 'Definition' of TRALI

Click here to read about Pathophysiology of TRALI

Click here to read about Clinical Presentation of TRALI

Click here to read about Treatment of TRALI

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What to read for FNB enterance???

This is the most confusing question….because critical care is a really vast topic….

FNB Enterance has 2 steps… Total 115 marks

1. Theory: 100 multiple choice questions for 100 marks                       

Books to read:

- Paul Marino

- Washington Manual Of Critical Care

- Hemodynamic Monitoring from Miller

- Antibiotics from any good Pharmacology book

Weightage for DNB Qualification: 5 marks

2. Aptitude Test: 10 marks

- Read about latest Guidelines and Studies and Review Articles

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