Report of a patient with severe transfusion-related acute lung injury after multiple transfusions, resuscitated with albumin

Objective: To report a patient with a large gastrointestinal stromal tumor (GIST) who received Multiple blood transfusions intraoperatively and developed a transfusion-related acute lung injury (TRALI). Design: Case report. Setting: Intensive care unit of a tertiary care hospital. Patient and history: A 58-year-old man with GIST metastatic to the right lobe of the liver, treated with tyrosine kinase inhibitors, underwent a right hepatectomy requiring multiple transfusions. Prior to abdominal closure, he developed copious pulmonary secretions, hypoxemia, and hypotension. Chest radiograph revealed diffuse bilateral infiltrates. Intervention: Volume resuscitation, vasopressors, high PEEP mechanical ventilation, paralysis, nitric oxide, steroids, rapid albumin infusion. Measurements and main results: Extensive noneardiogenic pulmonary edema. After unsuccessful fluid resuscitation with crystalloid fluid, the patient's condition improved rapidly with human albumin boluses. No neurological deficit was detected despite prolonged hypoxemia. Acute renal failure required dialysis but with Subsequent recovery. Patient was discharged home on postoperative day 19. Conclusion: Rapid infusion of albumin might be a rescue option in cases of severe TRALI with extensive pulmonary capillary leak during the acute phase. (c) 2005 Elsevier Ireland Ltd. All rights reserved.