[HSF] A TRALI case

[Hgrmd at aol.com]

Ani,
  Yes, it was heartbreaking.  The guy was only 57.   Actually, I did a small 
incision ASD closure and Cryomaze.  He was in  chronic AF.  He came off with 
no drips, NSR, and a perfect  TEE.  I do routinely get an intraop fibrinogen 
and platelet count, so that  I can anticipate the need for blood products.  I 
know the J.W.'s among us  will disparage this policy, but my blood bank can be 
slow.  I hate standing  there a couple of hours after CPB, slurping the field 
and waiting for the blood  products. The platelets were given after the 
protamine.  The first  hint of trouble was a gush of thin red fluid from the ETT when 
transferring the  patient from the table to the bed.  The process rapidly 
progressed, and he  ultimately died 6 hours postop.  
  I'm knowledgeable about a few things- hematology isn't one of  them.  I 
remember the pathologist saying it was TRALI, as confirmed  histologically.  In 
21 years of active cardiac surgery, I'd never seen a  case.  Hopefully, it'll 
be at least another 21 years before I see it  again.  
Hal 



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