Record number:
1089
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
54 of 86 patients (63%) with a mean age of 67.6 years old undergoing extensive surgery developed respiratory failure (PaO2/FiO2 <300mmHg) after intraoperative apheresis platelet transfusion. 23 cases diagnosed as TACO (26.7%) based on acute hydrostatic pulmonary edema diagnosed by the presence of perihilar vascular engorgement and/or mediastinal enlargement on chest x-ray within 6 hours. Multivariate logistic regression showed age (OR=1.146) and presence of anti-HLA class II antibody in the transfused platelets (OR= 18.4) as significant independent predictors of TACO.
Time to detection:
< 6 hours
Alerting signals, symptoms, evidence of occurrence:
Active surveillance within 6 hours of platelet transfusion. Respiratory failure defined as PaO2/FiO2 <300mmHg. Independent. All enrolled patients had chest xrays evaluated by independent radiologist for the presence of permeability pulmonary edema or hydrostatic pulmonary edema.
Demonstration of imputability or root cause:
Gajic et al 2006 guidelines for the diagnosis of TACO and Ely et al. 2001 for criterion of circulatory overload. Consult with anesthesiologist and intensivist, final diagnosis by radiologist.
Keywords:
Suggest references:
Kanai R, Iijima T, Hashimoto S, et al. Impact of immunoreactive substances contained in apheresis platelet concentrate on postoperative respiratory function in surgical patients receiving platelet transfusion: a prospective cohort study. Transfus Med. 2013 Oct;23(5):344-50