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

Eriko Nakashima, Motoaki Shiratsuchi, Emi Honda, Eriko Fujioka, Hirofumi Ohno, Yasuhiro Nakashima, Takamitsu Matsushima, Hiromi Iwasaki, Yasunobu Abe, Ryoichi Takayanagi

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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.

Original languageEnglish
Pages (from-to)378-382
Number of pages5
Journal[Rinshō ketsueki] The Japanese journal of clinical hematology
Issue number4
Publication statusPublished - Apr 1 2013

All Science Journal Classification (ASJC) codes

  • Medicine(all)


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