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Fresh-Frozen Plasma and Platelet Transfusions Are Associated With Development of Acute Lung Injury in Critically Ill Medical Patients^*

^* From the Department of Internal Medicine (Drs. Khan, Belsher, Yilmaz, Afessa, Hubmayr, and Gajic), Division of Pulmonary and Critical Care Medicine, and the Department of Laboratory Medicine and Pathology (Drs. Moore and Winters), Division of Transfusion Medicine, Mayo Clinic College of Medicine, Rochester, MN.

Correspondence to: Ognjen Gajic, MD, FCCP, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: gajic.ognjen{at}mayo.edu

Abstract

Background: Transfusion has long been identified as a risk factor for acute lung injury (ALI)/ARDS. No study has formally evaluated the transfusion of specific blood products as a risk factor for ALI/ARDS in critically ill medical patients.

Method: In this single-center retrospective cohort study, 841 consecutive critically ill patients were studied for the development of ALI/ARDS. Patients who received blood product transfusions were compared with those who did not, in univariate and multivariate propensity analyses.

Results: Two hundred ninety-eight patients (35%) received blood transfusions. Transfused patients were older (mean [± SD] age, 67 ± 17 years vs 62 ± 19 years; p < 0.001) and had higher acute physiologic and chronic health evaluation (APACHE) III scores (74 ± 32 vs 58 ± 23; p < 0.001) than those who had not received transfusions. ALI/ARDS developed more commonly (25% vs 18%; p = 0.025) in patients exposed to transfusion. Seventeen patients received massive RBC transfusions (ie, > 10 U of blood transfused within 24 h), of whom 13 also received fresh-frozen plasma (FFP) and 11 received platelet transfusions. When adjusted for the probability of transfusion and other ALI/ARDS risk factors, any transfusion was associated with the development of ALI/ARDS (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.24 to 3.75). Among those patients receiving individual blood products, ALI/ARDS was more likely to develop in patients who received FFP transfusions (OR, 2.48; 95% CI, 1.29 to 4.74) and platelet transfusions (OR, 3.89; 95% CI, 1.36 to 11.52) than in those who received only RBC transfusions (OR, 1.39; 95% CI, 0.79 to 2.43).

Conclusion: Transfusion is associated with an increased risk of the development of ALI/ARDS in critically ill medical patients. The risk is higher with transfusions of plasma-rich blood products, FFP, and platelets, than with RBCs.

Key Words: cohort study • fresh-frozen plasma • platelets • pulmonary edema • risk factor • transfusion-related acute lung injury

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