[HSF] A TRALI case

[Hgrmd at aol.com]

Ani,
  A few provocative statements, I'd say!  If you think it's  uncommon for 
abnormal coagulation profiles to cause postop bleeding, then your  experience is 
significantly different from mine.  I can't tell you the  number of patients 
I've seen postop with thin bloody drainage who stop bleeding  once the INR or 
the platelet count has been corrected.
  You are absolutely right that ECMO should have been started.   
Unfortunately, the nurse taking care of the patient didn't notify me of the  deteriorating 
oxygenation and hemodynamics until very late in the course.   As soon as I 
heard what was going on, I ran back to the hospital and inserted an  IABP.  
Twenty minutes later, the patient coded.  Having never seen or  heard of TRALI, I 
thought that this must be some sort of cardiac  dysfunction.  In the future, 
my index of suspicion will always be there,  and, of course, I'll institute 
ECMO sooner than later.
Hal



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