[HSF] A TRALI case

[Ben Bidstrup]

Many years ago I was in a big cold country north of the US and was a 
VP at a big institution. We were discussing use of blood products and 
how the residents would treat the path form not the patient, e.g. 
platelets if the count was <100,000 etc. I said do you look at the 
bleeding? No, they just treated the numbers. Saw same guy about 6 
months later and he thanked me for the $avings they had made. They 
treated the bleeding patient with appropriate products and left the 
stable dry ones alone. The saving was in the order of several 100K if 
I recall correctly (and that was in 1990).  Who knows what other 
iatros was avoided.

George Despotis has written about the targeted use of blood products 
in the same vein.



>Hal, lot of patients have abnormal profiles immediately post CPB but 
>do not need transfusions. How do you differentiate them.
>Claudia - I was thinking you will take the bait.
>Prasanna
>
>Hgrmd at aol.com wrote:
>>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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-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon