Transfusion-related acute lung injury during the treatment of EBV-associated hemophagocytic lymphohistiocytosis

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  • NAKASHIMA Eriko
    Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University Internal Medicine, Clinical Research Institute, National Hospital Organization Kyushu Cancer Center
  • SHIRATSUCHI Motoaki
    Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University
  • HONDA Emi
    Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University
  • FUJIOKA Eriko
    Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University
  • OHNO Hirofumi
    Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University
  • NAKASHIMA Yasuhiro
    Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University
  • MATSUSHIMA Takamitsu
    Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University
  • IWASAKI Hiromi
    Center for Cellular and Molecular Medicine, Kyushu University Hospital
  • ABE Yasunobu
    Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University Department of Hematology, National Hospital Organization Kyushu Cancer Center
  • TAKAYANAGI Ryoichi
    Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University

Bibliographic Information

Other Title
  • EBV関連血球貪食症候群加療中に発症した輸血関連急性肺障害
  • 症例報告 EBV関連血球貪食症候群加療中に発症した輸血関連急性肺障害
  • ショウレイ ホウコク EBV カンレン ケッキュウドンショク ショウコウグン カリョウ チュウ ニ ハッショウ シタ ユケツ カンレン キュウセイ ハイ ショウガイ

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Abstract

Transfusion-related acute lung injury (TRALI) is a severe pulmonary complication following blood transfusions. We experienced a case of possible TRALI during the course of EBV-associated hemophagocytic lymphohistiocytosis (EBV-HLH). A 19-year-old woman was admitted to our hospital suffering from fever and abdominal pain. Her laboratory data revealed pancytopenia, liver damage, coagulopathy, and a high titer of EBV-DNA. Computed tomography showed hepatosplenomegaly and bone marrow aspiration revealed hemophagocytosis and the proliferation of atypical lymphocytes. A diagnosis of EBV-HLH was made and plasma exchange was performed. Severe hypoxia due to pulmonary edema developed two hours after starting the plasma transfusion. Methylprednisolone pulse therapy and non-invasive positive pressure ventilation ameliorated her respiratory condition. Anti-HLA class I and II antibodies were detected in donor sera and a cross-match test between patient lymphocytes and donor plasma was positive. To the best of our knowledge, this is the first case report of TRALI complicated with EBV-HLH. It is possible that hypercytokinemia accompanied by HLH was associated with the onset of TRALI.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 54 (4), 378-382, 2013

    The Japanese Society of Hematology

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