G363(P) Transfusion associated lung injury (trali) vs transfusion associated circulatory overload (taco): a complication of blood transfusion in paediatric intensive care (picu). (May 2019)

• Record Type: Journal Article
• Authors: Martin, SK; Theilen, U
• Is Part Of: Archives of disease in childhood. Volume 104:(2019)Supplement 2
• Page Start: A148
• Page End: A148
• Publication Date: 2019-05
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2019-rcpch.350
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : A 14 year old boy with a complex background of Spina-Bifida and chronic lower limb osetomyelitis with associated ulcer. There was a long history of poor compliance with treatment. During this admission multiple assessments by CAHMS as declining treatment and concerns re-capacity. Assessed by CAHMS following extensive assessment the patient was felt not to have capacity. He was fulminantly septic and he was admitted to PICU in septic shock. He was intubated and ventilated on admission. He was commenced on adrenaline, noradrenaline and hydrocortisone. Vancomycin and clindamycin were started. Initial bloods revealed he was suffering from disseminated intravascular coagulation (DIC) and he was therefore given multiple pools of platelets and 1 xunit of packed red cells (RCC). DIC gradually resolved but his consumptive coagulopathy continued. Some fresh blood seen in ETT 5 days after admission so further platelet transfusion given. 5 hours post platelets the patient suffered an acute deterioration. He was profoundly hypoxic saturations were 80%–100% O2 to maintain sats>90% PO2 on arterial gas in 90% O2 was 7. A chest Xray demonstrated appearances consistent with acute pulmonary oedema/ARDS. Ventilation pressures were increased and 15 mg of IV furosemide was given. On call haematology/BTS consultant called. Concerns that this could be either a transfusion associated lung injury or transfusion associated circulatory overload. There are no gold standard guidelines that describe how to appropriately manage TRALI/TACO. All of the available lierature suggests that on average affected patients will require 2–5 days of additional invasive respiratory support and treatment remains largely supportive. This patient was re-commenced on adrenaline/noradrenaline and milrinone for 24 hours having previously been weaned off all inotropic support. The patient was also commenced on a furosemide infusion. His ventilation was gradually weaned and his ARDS gradually improved. The patient was extaibted 72 hours after his acute episode of deterioration.