Transfusion-related acute lung injury (TRALI) is a rare complication of blood transfusion characterized by acute lung injury within 6 hours of transfusion. It is difficult to diagnose due to a lack of clear defining criteria. Two mechanisms are proposed - antibodies in donor blood products cause activation of recipient neutrophils (single hit model) or antibodies interact with primed recipient neutrophils/pulmonary endothelium (two hit model). Risk factors include plasma-containing blood products from multiparous female donors or those stored for a long duration. Treatment involves stopping the transfusion and providing supportive care. Preventive strategies aim to reduce donor antibodies by excluding high-risk donors or using leukoreduction filters. TRALI must be differentiated from trans
This workshop will outline the basic principles of extracorporeal life support made easy by key-experts in the field. During the course delegates will gain a good understanding of ECMO in the following areas: Theoretical concepts, basic physiology and pathophysiology, cardiac and respiratory support and monitoring, alarm settings and monitoring, role of cardiac ultrasound during ECMO, newest technologies, circuits and devices, practical hands-on sessions and simulations.
This workshop will outline the basic principles of extracorporeal life support made easy by key-experts in the field. During the course delegates will gain a good understanding of ECMO in the following areas: Theoretical concepts, basic physiology and pathophysiology, cardiac and respiratory support and monitoring, alarm settings and monitoring, role of cardiac ultrasound during ECMO, newest technologies, circuits and devices, practical hands-on sessions and simulations.
its sometime difficult to decide in urgent clinical scenarios - Trauma,active bleeding, surgery: What ; when ; how and why to transfuse? answering some of these queries here is my presentation especially made for PG students (will help in answer writing)
amniotic fluid embolism and cardiac arrest in pregnancyprateek gupta
obstetric emergency. amniotic fluid embolism-pathophysiology,clinical presentation, diagnosis, treatment, laboratory investigations and prognosis. cardiac arrest in preganacy and ACLS 2015 guidelines for CPR and new updates
its sometime difficult to decide in urgent clinical scenarios - Trauma,active bleeding, surgery: What ; when ; how and why to transfuse? answering some of these queries here is my presentation especially made for PG students (will help in answer writing)
amniotic fluid embolism and cardiac arrest in pregnancyprateek gupta
obstetric emergency. amniotic fluid embolism-pathophysiology,clinical presentation, diagnosis, treatment, laboratory investigations and prognosis. cardiac arrest in preganacy and ACLS 2015 guidelines for CPR and new updates
Disseminated intravascular coagulation (DIC) is a condition in which blood clots form throughout the body, blocking small blood vessels. Symptoms may include chest pain, shortness of breath, leg pain, problems speaking, or problems moving parts of the body.
A condition affecting the blood's ability to clot and stop bleeding.
In disseminated intravascular coagulation, abnormal clumps of thickened blood (clots) form inside blood vessels. These abnormal clots use up the blood's clotting factors, which can lead to massive bleeding in other places. Causes include inflammation, infection and cancer.
Acute pulmonary embolism and its management.Puja Gupta
Critical Care Nursing (CCN).Respiratory disorders. Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).Critical Care Nursing (CCN).
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. Introduction
• Transfusion-related acute lung injury (TRALI)
represents Acute Lung Injury(ALI) after transfusion of
one or more plasma-containing blood products
developing within 6 hours of completion of transfusion.
• Though not uncommon it is difficult to prove as the cause
for the ALI as there is lack of knowledge about it.
• It has emerged as the most important cause of morbidity
and mortality resulting from blood transfusion.
• .
3. • Transfusion-related acute lung injury (TRALI) is a rare
complication of blood transfusion.
• The incidence reported in 1985 was 1 in 5000 U transfused. But
recent studies shows that incidence is 1 in1000 to 2400 units.
• Plasma containing blood components such as whole blood,
platelet concentrates , fresh frozen plasma, packed red cells,
granulocytes , cryoprecipitate and intravenous
immunoglobulin have all been implicated as a possible cause of
TRALI.
4. Clinical features of transfusion-related acute lung injury
Dyspnoea/respiratory distress requiring oxygen support Virtually all
Requiring mechanical ventilation 70%
Documented hypoxemia Virtually all
Cyanosis Very common
Hypotension Majority
Fever Very common
Hypertension Unusual
6. • A Working Party on Definitions of Adverse Transfusion Events
was established by the European Haemovigilance Network
(EHN). This group has suggested that the following be the
minimum requirements for a clinical diagnosis of TRALI:
• 1) the occurrence of acute respiratory distress during or within 6
hrs of transfusion;
• 2) absence of signs of circulatory overload;
• 3) radiographic evidence of bilateral pulmonary infiltrates.
7. • Also has been defined by the "Canadian Consensus Conference
Panel on TRALI" and by "National Heart, Lung, and Blood
Institute (NHLBI) Working Group on TRALI" as new acute lung
injury (ALI) within six hours of a completed transfusion.
• Applying this definition, TRALI is a clinical syndrome, rather than
a disease with a single aetiology .
8. Canadian Consensus Conference Proposed Criteria for
Transfusion -Related Acute Lung Injury (TRALI)
Criteria for TRALI
Acute lung injury (ALI)
Acute onset Hypoxemia
In research setting
Ratio of PaO2/FiO2 <300 or
SpO2 <90% at room air
Non research setting
Ratio of PaO2/FiO2 <300 or
SpO2 <90% at room air
Other clinical evidence of hypoxia
Bilateral infiltrates on frontal chest radiograph
No evidence of left atrial hypertension (i.e., circulatory overload)
No preexisting AL I before transfus ion d uring or within 6 h of transfusion; and
No temporal relationship to an alternative risk factor for ALI
Criteria for possible TRALI
Acute lung injury (ALI )
No preexisting ALI before transfusion
During or within 6 h of transfusion; and
A clear tempora l rela tionship to an alternative risk factor for ALI
9. The National Heart, Lung, and Blood Institute (NHLBI) Working
Group recognized that ALI in patients with other recognized risk
factor (such as trauma, sepsis) would be difficult to classify as
TRALI and such cases would be designated as "indeterminate."
• The Consensus Panel designates these "indeterminate" cases
as "possible TRALI," a category used by the Consensus Panel
for cases in which ALI is temporally related to a transfusion in
the presence of one other risk factor for ALI.
• The guidelines recommend classifying each suspected case in
one of the following 3 categories: (1) "TRALI,"(2) "Possible
TRALI," or (3) "Not TRALI".
10. • Laboratory tests which strongly support, but are not required for
the clinical diagnosis of TRALI, include the
• Demonstration of human leukocyte antigen (HLA) class I or class
II or
• Neutrophil-specific antibodies in donor plasma .
12. • The exact pathogenesis of TRALI is not known, thus several
theories have been proposed. Two basic mechanisms have
been proposed for the pathogenesis of TRALI for
immune competent hosts,
(1) single event hypothesis
(2) Two-event model
13.
14. • Other possible mechanisms - Several other explanations for
TRALI have been suggested, but these are not supported by
clinical and experimental evidence.
• These include direct injury to pulmonary endothelium,
• Immune complex formation with complement activation, and
• Cytokine network activation .
16. Multiparous donors
Blood components: platelet Concentrates>fresh frozen
plasma>packed red cells>granulocytes>cryoprecipitate>
intravenous immunoglobulin
Massive transfusion
• Stored blood products: Inflammatory mediators like cytokines
and lipid soluble substances accumulate during storage of blood
products,
• Underlying clinical condition: Factors such as trauma, major
surgery, sepsis may serve as initial priming event in the
development of TRALI (Two event hypothesis).
18. Immediate Actions When Considering the
Diagnosis of Transfusion -Related Acute Lung Injury
1. Stop the transfusion immediately.
2. Support the patient.
3. If the patient is intubated, obtain undiluted edema fluid as soon as possible
(preferably within 15 min), and simultaneous plasma for determination of total protein
concentrations.
4. Obtain a complete blood count with differential and chest radiograph.
5. Notify the blood bank of possible transfusion-related acute lung injury, request a
different unit, and quarantine other units from the same donor.
6. Follow institutional policies for a trans fusion reaction workup, and send blood
bank:
• A patient blood specimen
• Bags from units of blood transfused in the last 6 h
• A copy of transfus ion record forms
• Indicate the last unit transfused if possible
• Results of the patient’s human leukocyte antigen type if available
19. • For mild TRALI cases, supplemental oxygen and supportive
care may be sufficient.
• For the most severe cases, IV fluids, mechanical or non-
invasive ventilation and invasive cardiovascular monitoring
may be required. A low tidal volume strategy with low plateau
pressures should be employed when ventilating TRALI
patients, just like other causes of ALI/ARDS.
• Extracorporeal membrane oxygenation has been used
successfully in a severe case of TRALI.
• Other, less well-documented and unproven therapies (eg.
diuretics, corticosteroids, prostaglandin E1) have also been
used.
21. • Avoiding blood from multiparous women: these women are at the
risk of producing anti-leucocyte antibodies during previous
pregnancies.
• Donors whose blood has resulted in TRALI like reaction
previously.
• Blood which has been stored for long duration: long storage
results in production of anti-leucocyte antibodies.
• Not using whole blood.
• Leukoreduction: can be done by ɤ - irradiation of the blood
component,or by using micro filters in the transfusion sets,or by
using centrifuged blood component which has reduced leucocytes.
23. • There is no universally agreed-upon definition for what
constitutes TACO .
• During or within several hours of transfusion, If patients
develop respiratory distress, orthopnea, cyanosis,
tachycardia, and hypertension.
• Rales on auscultation,
• Some patients may have raised JVP, an S3 on cardiac
auscultation, or lower limb edema. A chest radiograph can
reveal cardiomegaly and interstitial infiltrates.
All patients with TACO may not have all these
abnormalities.
24. Highest risk for TACO include those younger than 3 and
those older than 60 years of age, particularly those with
underlying cardiac dysfunction.
The pathogenesis of TACO is similar to other
causes of acute congestive heart failure: an increase in
central venous pressure and pulmonary blood volume
causes an increase in hydrostatic pressure leading to fluid
extravasation into the alveolar space
25. Treatment of TACO starts with discontinuing any
ongoing transfusion.
Respiratory distress is treated with
the degree of respiratory support needed to maintain the
patient’s oxygenation.
Diuretics are administered to
remove excess fluid.
27. With above discussion it is still difficult to
distinguishe between the TRALI and TACO.
Clinical presentation
Both TRALI and TACO are clinical diagnoses, and
clinical features can sometimes distinguish between them.
With both, patients present with respiratory distress due to
acute onset pulmonary edema.
With TRALI, patients often have hypotension and fever, and can
have transient leukopenia.
With TACO, one would typically expect hypertension and a lack
of fever and leukopenia..
28. Features sometimes seen with TACO that would not be expected
in TRALI include raised JVP , an S3 heard on cardiac
auscultation, and peripheral edema.
Fluid balance
A careful investigation of the patient’s fluid balance can
sometimes provide a clue to the underlying diagnosis in patient
with excess fluid intake pre transfusion or
significant diuresis post reaction , TACO should be
considered. A normal fluid balance does not however rule
out TACO or rule in TRALI.
29. Cardiac function
Evidence of a new myocardial infarct can suggest that
pulmonary edema may not be transfusion related.
Patients with known preceding congenital heart disease
are at risk for TACO.
Systolic dysfunction identified
on echocardiography is also suggestive of TACO ,
but does not rule out TRALI.
30. Biochemical markers
Elevated levels of brain natriuretic peptide (BNP) and
n-terminal pro-brain natriuretic peptide (NT-proBNP)
are established markers for congestive heart failure.
These BNP levels can be used to distinguish between
cardiogenic and non cardiogenic pulmonary edema in patients
presenting with acute respiratory failure.
31. Comparison of the features of transfusion related acute lung
injury and transfusion associated circulatory overload.
• Feature TRALI TACO
• Temperature Fever is present no fever
• Blood pressure Hypotension Hypertension
• Respiratory
symptoms Acute dyspnea Acute dyspnea
• JVP Unchanged Can be raised
• Auscultation Rales Rales + S3
35. Reference
• Goldman M, Webert KE, Arnold DM, Freedman J, Hannon J, Blajchman MA.
Proceedings of a consensus conference: towards an understanding of TRALI. Transfus
Med Rev 2005;19:2–31.
• Pradeep et al. TRAL-A less commonly known complication of transfusion. Indian
journal of anaesthesia 2008; 52(2): 126-131.
• Christopher C. Silliman, Daniel R. Ambruso, and Lynn K. Boshkov. Transfusion-
related acute lung injury. Blood. 2005;105:2266-2273
• Bhatia P, Tulsiani KL. TRALI - A Less Commonly Known Complication of Transfusion.
Indian J Anaesth 2008;52:126-31
• Popovsky, M. A. and Moore, S. B. (1985), Diagnostic and pathogenetic considerations
in transfusion-related acute lung injury. Transfusion, 25: 573–577. doi: 10.1046/j.1537-
2995.1985.25686071434.x
• Kleinman S, Caulfield T, Chan P, et al: Toward an understanding of transfusion-relate
acute lung injury: Statement of a consensus panel. Transfusion 2004; 44:1774–1789
• Silliman CC, Bjornsen AJ, Wyman TH, et al. Plasma and lipids from stored platelets
cause acute lung injury in an animal model. Transfusion 2003;43:633-40.
• Sachs UJ., Recent insights into the mechanism of transfusion-related acute lung injury.
Curr Opin Hematol. 2011 Nov;18(6):436-42