Transfusion Related Lung Injury- TRALIUna mattina come tante arrivo in sala medici e mi riferiscono che un mio paziente, 8. Linfoma Non Hodgkin Mantellare, . Tali criteri identificano due entit. In numerosi studi eseguiti su modello animale . I neutrofili del ricevente vengono attivati o direttamente, attraverso il legame tra anticorpi e superficie dei neutrofili, o indirettamente attraverso il legame tra anticorpo e cellula endoteliale (Ab anti HLA classe I/ classe II ) con conseguente attivazione dei neutrofili e successivo danno endoteliale. La diagnosi viene fatta attraverso l’identificazione di anticorpi del donatore diretti contro HLA classe I o II del ricevente. Alcune volte non risulta possibile identificare tali Anticorpi, da qui il second hit non anticorpo- mediato.> > non anticorpo- mediatovi sono delle teorie e degli studi a riguardo. Sembrerebbe in un primo studio che . Un’altra teoria invece riguarda l’infusione di globuli rossi . Sembrerebbe infatti che anche se debitamente conservato, i globuli rossi presenti nelle sacche possano andare in contro a cambiamenti morfologici, perdita di antigeni di superficie, Duffy antigen, e che possano essere maggiormente aderenti all’endotelio, causando , nel modello animale utilizzato per lo studio, ipossia e stravaso del globulo rosso nello spazio alveolare con danno endoteliale. Sempre sulla review su Lancet del 2. Fattori di rischio: -ventilazione meccanica: sembra che lo stress derivato dalle pressioni esercitate dalle diverse tipologie di ventilazione meccanica possa favorire la comparsa di TRALI- chirurgia: maggior concentrazione in circolazione di citochine proinfiammatorie- stato settico: alta concentrazione in circolo di citochine proinfiammatorie - intensa necessit. Tali sintomi sono correlati ad infiammazione ed incremento della permeabilit. A questi sintomi si possono associare quelli di tipo anafilattico dovuti all’infusione di anticorpi quali tachicardia, rigor, ipotensione, ipotermia e febbre. Come diagnosticarla? Imaging> all’ RX il risultato . L’esecuzione dell’esame avviene in decubito supino in accordo con il protocollo BLUE(Bedside Lung Ultrasound in Emergency) . L’identificazione di strie B, cio. L’ecocardiogramma ha permesso di differenziare la TRALI da fluid overload causata da scompenso cardiaco, registrando una normale frazione di eiezione, normale dimensione delle camere cardiache ed una normale pressione di riempimento ventricolare destro. Negli esami ematici> neutropenia e trombocitopenia possono essere presenti (ma non sempre) specialmente nelle sindromi anticorpo- mediate in cui ho un’azione dell’anticorpo diretta contro i neutrofili. In questo caso il centro trasfusionale deve essere contattato, la sacca suddetta deve essere conservata in maniera da permettere l’identificazione del donatore ed il successivo screening anticorpale. Se conferma di positivit. RX ed ecografia toracica in questo caso non presenteranno segni si edema polmonare. Altre indagini come ecocardio e BNP possono essere utili nella diagnostica differenziale. I diuretici possono aiutare in quanto sembrerebbe che un bilancio di fluidi in positivo possa precipitare la gravit. Utile quindi inserire nella lista delle diagnosi differenziali anche quella di TRALI quando il paziente che stiamo trattando sviluppa dispnea o desaturazione ed . Di fondamentale importanza di fatti . Alexander P J Vlaar, Nicole P Ju. Lancet 2. 01. 3; 3. Case Reports in Critical Care 2. Relevance of lung ultrasound in the diagnosis of acute respiratoru failure. Chest 2. 00. 8; 1. Pulmonary edema after. Toko herbal grosir murah,grosir herbal,jual herbal,kosmetik herbal,minuman herbal propolis,gamat,madu habbatussaudah,minyak herbal,herbal alami,madu anak murni.Transfusion Related Lung Injury come acronimo TRALI Revisione dello stato delle conoscenze su definizione, eziopatogenesi, diagnosi, prognosi e terapia. Classic and delayed transfusion-related acute lung injury syndromes (TRALI) manifest differently and have mortality rates that are also dramatically different. Troli kupujte od prov. Encomiendas, Transportes, Mudanzas, Tourist Transports, Parcel Service, Movers de San Jose San Jos Trolibusz.Budapest.Hu Szerkeszt
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