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Insuficiencia respiratoria pulmonar aguda y transfusión
Resumen
La insuficiencia respiratoria aguda es una complicación frecuente en pacientes críticos. La Food and Drug Administration la identifica en los primeros lugares de causa de muerte por transfusión. La transfusión se puede manifestar como síndrome de insuficiencia respiratoria pulmonar aguda (SIRPA), sobrecarga circulatoria por transfusión (síndrome TACO) y síndrome de insuficiencia respiratoria aguda secundaria a transfusión (TRALI), en los cuales se observan disnea de instalación súbita, infiltrados pulmonares bilaterales (en la radiografía de tórax) e hipoxia de 90 % o menor. La producción del TRALI se ha atribuido a anticuerpos antileucocitos contenidos en el plasma del componente transfundido, específicos contra los antígenos leucocitarios de los pacientes. Es muy probable que el blanco de la acción nociva de los anticuerpos antileucocitos y de las sustancias en el plasma almacenado sean las células endoteliales de los capilares pulmonares, las cuales están afectadas por un estado inflamatorio previo; esto último ha sido planteado como mecanismo de producción, semejante al fenómeno de Sanarelli–Shwartzman. La prevención de estos síndromes está en evitar la transfusión insuficientemente fundamentada en pacientes críticos.
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