Resumen
La lesión pulmonar aguda producida por transfusión (TRALI) es un grave síndrome clínico que se presenta con hipoxemia aguda y edema pulmonar no cardiogénico dentro de las 6 h de una transfusión con productos sanguíneos.
La incidencia reportada oscila entre 1 caso cada 5000 a 100000 trasfusiones.
Dos teorías han sido propuestas en su fisiopatología, una inmunomediada y otra no-inmune.
El diagnóstico es clínico, y el tratamiento es de sostén.
La mortalidad puede llegar al 10%, presentando elevada morbilidad.
Presentamos el caso de un paciente que cursando el postoperatorio inmediato de artrodesis posterior instrumentada por escoliosis, progresa con hipoxemia refractaria. Durante el acto quirúrgico requirió múltiples trasfusiones con hemoderivados por sangrado activo, por lo que se arriba al diagnóstico de TRALI. Requirió asistencia respiratoria mecánica con altos parámetros durante 72 h y sostén hemodinámico por bajo gasto cardíaco. Evoluciona favorablemente.
Citas
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