Transfusion-related acute lung injury (TRALI) during remission induction course of acute myeloid leukemia: A possible role for all-transretinoic-acid (ATRA)?

• Published in: Pathologie biologie (Paris) Vol. 57; no. 6; pp. 500 - 502
• Main Authors: Jeddi, R., Mansouri, R., Kacem, K., Gouider, E., Abid, H.B., Belhadjali, Z., Meddeb, B.
• Format: Journal Article
• Language: English
• Published: Paris Elsevier SAS 01.09.2009; Elsevier
• Subjects: Acide tout transrétinoïque; Acute lung injury; Acute myeloid leukemia; Adult; Anemia - etiology; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antineoplastic Agents - therapeutic use; ATRA; Biological and medical sciences; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Détresse respiratoire aiguë; Female; Flow Cytometry; Hematologic and hematopoietic diseases; Humans; Leucémie aiguë myéloïde; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - pathology; Leukemia, Myeloid, Acute - therapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Leukocytosis - etiology; Medical sciences; Remission Induction - methods; Respiratory Distress Syndrome, Adult - etiology; Transfusion; Transfusion Reaction; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Tretinoin - therapeutic use; Acute lung injury; Transfusion; Leucémie aiguë myéloïde; Détresse respiratoire aiguë; Acide tout transrétinoïque; ATRA; Acute myeloid leukemia; Human; Antineoplastic agent; Blood product; Acute myelogenous leukemia; Respiratory disease; Malignant hemopathy; Induction treatment; Transfusion related acute lung injury; Case study; Chemotherapy; Treatment; Lymphoproliferative syndrome; Young adult; Respiratory distress; Female; Remission; Cancer; Tretinoin
• ISSN: 0369-8114; 1768-3114; 1768-3114
• DOI: 10.1016/j.patbio.2008.06.005

Transfusion-related acute lung injury (TRALI) is a clinical syndrome characterized by sudden onset of respiratory distress due to pulmonary edema during or following transfusion. Two proposed pathophysiologic mechanisms for TRALI were proposed: the antibody hypothesis and the two-event hypothesis. The two-event hypothesis postulates that a pathway to neutrophil activation and aggregation can occur without leukocyte antibodies. We report a case of TRALI occurring during remission induction course of acute myeloid leukemia in a 27-year-old woman who received All-transretinoic-acid (ATRA). We postulate that ATRA may have played a role in this life-threatening complication by priming neutrophil and enhancing their adherence and their activation in the pulmonary endothelium. TRALI improved with non-invasive ventilation support and use of high dose corticosteroids. Le TRALI ( Transfusion-related acute lung injury) est un syndrome de détresse respiratoire aiguë survenant dans un contexte transfusionnel. Il est le reflet d’un œdème pulmonaire lésionnel. Le mécanisme physiopathologique implique la succession de deux étapes : la première responsable d’une activation de l’endothélium pulmonaire entraînant stase et stimulation des polynucléaires. La seconde est représentée par l’activation de ces polynucléaires séquestrés sous l’effet d’anticorps ou de lipides apportés par la transfusion. Nous rapportons un cas de TRALI survenant durant la cure d’induction d’une leucémie aiguë myéloïde chez une femme âgée de 27 ans qui a reçu l’acide tout transrétinoïque (ATRA). Nous discutons un possible rôle de l’ATRA dans la survenue de cette complication. L’évolution a été favorable sous ventilation non invasive et corticothérapie à forte dose.