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Anesthesiology. 2019 Sep;131(3):693-715. doi: 10.1097/ALN.0000000000002687.

Transfusion-related Acute Lung Injury in the Perioperative Patient.

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From the Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada (M.J.M., J.W.S., W.M.K) Departments of Physiology and Anesthesia (M.J.M.) Pharmacology (J.W.S.) Laboratory Medicine-Pathobiology (C.C.-G.) Medicine-Division of Hematology (C.C.-G.) Anesthesia and Pain Management, University Health Network (K.K.) Physiology and Surgery (W.M.K.) University of Toronto, Toronto, Canada (C.C.-G.) Sickkids Department of Anesthesia and Pain Medicine (M.J.M.) Division of Hematology and Transfusion Medicine (R.K., J.W.S.), Lund University, Lund, Sweden Department of Experimental Immunohematology, Sanquin Research, and Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands (R.K.) Departments of Laboratory Hematology (Blood Transfusion Laboratory), Laboratory Medicine Program (C.C.-G.) Medical Oncology and Hematology (C.C.-G.) University Health Network, Toronto, Canada (K.K.) Department of Clinical Pathology, Blood and Tissue Bank, Sunnybrook Health Sciences Centre, Toronto, Canada (C.C.-G.) Institute of Physiology, Charité University Berlin, Berlin, Germany (W.M.K.).


Transfusion-related acute lung injury is a leading cause of death associated with the use of blood products. Transfusion-related acute lung injury is a diagnosis of exclusion which can be difficult to identify during surgery amid the various physiologic and pathophysiologic changes associated with the perioperative period. As anesthesiologists supervise delivery of a large portion of inpatient prescribed blood products, and since the incidence of transfusion-related acute lung injury in the perioperative patient is higher than in nonsurgical patients, anesthesiologists need to consider transfusion-related acute lung injury in the perioperative setting, identify at-risk patients, recognize early signs of transfusion-related acute lung injury, and have established strategies for its prevention and treatment.

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