Massive right-sided colon diverticular bleeding complicated by the transfusion related acute lung injury (TRALI)

• Authors: Ivana Urošević , Ivanka Perčić , Aleksandar Knežević , Aleksandar Savić , Ivanka Savić
• Languages of publication: EN

Abstracts

EN

Colonic diverticulosis is a condition which causes extensive bleeding of the lower gastrointestine in 40–50% of cases. In particular, right-sided diverticulosis, although uncommon requires lifesaving colectomy. Transfusion related acute lung injury (TRALI) is a transfusion reaction, which can occur after administration of various blood products. Although life threatening, it can be completely reversed usually within 72 to 96 hours. Here, we report a case of a young Caucasian male hospitalized due to severe anemia, hematochezia and extensive blood loss, all due to lower gastrointestinal hemorrhage from right-sided diverticulosis. These conditions were overlooked endoscopically and diagnosed then treated surgically with the right-sided hemicolectomy. During postoperative course, four hours after the last transfusion, patient developed fever, hypoxia and noncardiogenic pulmonary oedema, but made complete recovery through aggressive oxygen support within 96 hours. The aim of this case was to review current literature, to draw attention to a serious and under-diagnosed transfusion reaction, as well as discuss possible explanations for the diagnostic difficulties that occurred in this case.

Keywords

EN

Colonic diverticulosis; Blood transfusion; Acute lung injury; Gastrointestinal endoscopy

• Publisher: De Gruyter Open
• Journal: Open Medicine
• Year: 2012
• Volume: 7
• Issue: 6
• Pages: 716-719

Dates

published

1 - 12 - 2012

online

11 - 10 - 2012

Contributors

author

Ivana Urošević

• Clinic for Hematology, Clinical Center of Vojvodina, Hajduk Veljkova 1-3, 21000, Novi Sad, Serbia

author

Ivanka Perčić

• Emergency Center, Clinical Center of Vojvodina, Hajduk Veljkova 1-3, 21000, Novi Sad, Serbia

author

Aleksandar Knežević

• Emergency Center, Clinical Center of Vojvodina, Hajduk Veljkova 1-3, 21000, Novi Sad, Serbia

author

Aleksandar Savić

• Clinic for Hematology, Clinical Center of Vojvodina, Hajduk Veljkova 1-3, 21000, Novi Sad, Serbia

author

Ivanka Savić

• Clinic for Hematology, Clinical Center of Vojvodina, Hajduk Veljkova 1-3, 21000, Novi Sad, Serbia

References

• [1] Moore Breanndan S. Transfusion - related acute lung injury (TRALI): Clinical presentation, treatment, and prognosis. Crit Care Med 2006, 34 Suppluppl 5, 114–117 http://dx.doi.org/10.1097/01.CCM.0000214312.20718.3E[Crossref]
• [2] Triulzi DJ. Transfusion - related acute lung injury: An update. Hematology 2006, 497–501 [WoS]
• [3] Silliman CC, McLaughlin NJD. Transfusion - related acute lung injury. Blood Rev 2006, 20, 139–159 http://dx.doi.org/10.1016/j.blre.2005.11.001[Crossref]
• [4] Silliman CC, Ambruso DR, Boshkov LK. Transfusion - related acute lung injury. Blood 2005, 105(6), 2266–2273 http://dx.doi.org/10.1182/blood-2004-07-2929[Crossref]
• [5] P’Ng SS, Hughes AS, Cooney JP. A case report of transfusion-related acute lung injury during plasma exchange therapy for thrombotic thrombocytopenic purpura. Ther Apher Dial 2008, 12(1), 78–81 http://dx.doi.org/10.1111/j.1744-9987.2007.00545.x[WoS][Crossref]
• [6] Shander A, Popovsky MA. Understanding the consequences of transfusion - related acute lung injury. Chest 2005, 128, 598–604 http://dx.doi.org/10.1378/chest.128.5_suppl_2.598S[Crossref]
• [7] Curtis BR, Mc Farland JG. Mechanisms of transfusion - related acute lung injury (TRALI): Anti - leukocyte antibodies. Crit Care Med 2006, 34(5), 118–123 http://dx.doi.org/10.1097/01.CCM.0000214293.72918.D8[Crossref]
• [8] Fontaine MJ, Malone J, Mullins FM, Grumet FC. Diagnosis of transfusion-related acute lung injury: TRALI or not TRALI? Ann Clin Lab Sci 2006, 36(1), 53–58 [PubMed]
• [9] Fung YL, Goodison KA, Wong JKL, Minchinton RM. Investigating transfusion-related acute lung injury (TRALI). Intern Med J 2003, 33, 286–290 [Crossref][PubMed]
• [10] Silliman CC. The two - event model of transfusion - related acute lung injury. Crit Care Med 2006, 34 Suppluppl 5, 124–131 http://dx.doi.org/10.1097/01.CCM.0000214292.62276.8E[Crossref]
• [11] McQuaid KR. Gastrointestinal disorders. In: McPhee SJ, Papadakis MA. Current medical diagnosis and treatment 2009, Forty-Eight Edition. The McGraw-Hill Companies, 2009: 487–581
• [12] Stollman NH, Raskin JB. Diagnosis and management of diverticular disease of the colon in adults. Am J Gastroenterol 1999, 94(11), 3110–3121 http://dx.doi.org/10.1111/j.1572-0241.1999.01501.x[Crossref]
• [13] Steth AA, Longo W, Floch MH. Diverticular disease and diverticulitis. Am J Gastroenterol 2008, 103, 1550–1556 http://dx.doi.org/10.1111/j.1572-0241.2008.01879.x[Crossref]
• [14] Pilichos C, Bobotis E. Role of endoscopy in the management of acute divertcular disease. World J Gastroenterol 2008 April 7, 14(13), 1981–1983 http://dx.doi.org/10.3748/wjg.14.1981[Crossref]
• [15] Adams JB, Margolin DA. Management of diverticular hemorrhage. Clin Colon Rectal Surg 2009, 22(3), 181–185 http://dx.doi.org/10.1055/s-0029-1236163[Crossref]
• [16] Jensen DM, Machicado GA, Jutabha R, Kovacs TOG. Urgent colonoscopy for the diagnosis and treatment of severe diverticular hemorrhage. N Eng J Med 2000 Jan 13, 342(2), 78–82 http://dx.doi.org/10.1056/NEJM200001133420202[Crossref]
• [17] Hoedema RE, Luchtefeld MA. The management of lower gastrointestinal hemorrhage. Dis Colon Rectum 2005, 48, 2010–2024 http://dx.doi.org/10.1007/s10350-005-0138-1[Crossref]
• [18] Wong Kee Song LM, Baron TH. Endoscopic management of acute lower gastrointestinal bleeding. Am J Gastroenterol 2008, 103, 1881–1887 http://dx.doi.org/10.1111/j.1572-0241.2008.02075.x[Crossref]
• [19] Steel M. Colonic diverticular disease. Aust Fam Physician 2004, 33(12), 983–986 [PubMed]

Identifiers

DOI

10.2478/s11536-012-0079-8