Clin Lab
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Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion related morbidity and mortality. TRALI is suggested to be a "two hit" event. The "first hit" is the underlying condition of the patient which results in sequestration and priming of neutrophils in the pulmonary compartment. ⋯ Although it could be speculated that all of these factors may be involved in the onset of TRALI, only one pre-clinical study shows an association between the aged erythrocyte and the onset of TRALI. The suggested mechanism is a decrease in the chemokine scavenging function of the erythrocyte by reduction of the Duffy antigen expression resulting in an increase in lung injury. Further research is needed to elucidate possible mechanisms of onset of TRALI by aged blood products.
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Many children receive one or more units of red blood cell (RBC) preparations during their paediatric intensive care unit (PICU) admission depending on their underlying disease course. Physicians often justify RBC transfusions in critically ill children when anaemia is present because of the assumption that by increasing the haemoglobin level the delivery of oxygen (DO2) to peripheral tissues is improved so that ultimately the oxygen utilization (VO2) can be improved. ⋯ The TRIPICU study has clearly shown that it is safe to refrain from transfusing stable critically ill children unless their Hb has dropped below 7 g/dL (4.3 mmol/L) as increasing data emphasizes that the common practice of transfusing critically ill children is not free from causing harm as shown by increased morbidity and mortality. This narrative review summarizes the current literature and discusses possible pathophysiological mechanisms.