Letter to the Editor
In reply to “Acute respiratory distress secondary to blood transfusion”
En respuesta a «Distrés respiratorio agudo secundario a la transfusión sanguínea»
a Unidad de Cuidados Intensivos, Hospital Español de Buenos Aires-Hospital de Alta complejidad en red “El Cruce”, Dr. Néstor Carlos Kirchner, Buenos Aires, Argentina
b Unidad de Cuidados Intensivos, Hospital Universitario HM Sanchinarro, Madrid, Spain
c Servicio de Emergencia, Hospital Universitario HM Sanchinarro, Madrid, Spain
d Fundación de investigación HM Hospitales, Madrid, Spain
e Unidad de Cuidados Intensivos, Hospital Nacional Profesor Alejando Posadas, Buenos Aires, Argentina
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Correger, J. Villanueva, P. Cardinal-Fernández, F. Rios" "autores" => array:4 [ 0 => array:3 [ "nombre" => "E." "apellidos" => "Correger" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Villanueva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "P." "apellidos" => "Cardinal-Fernández" "email" => array:1 [ 0 => "pablocardinal@hotmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 3 => array:3 [ "nombre" => "F." "apellidos" => "Rios" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Unidad de Cuidados Intensivos, Hospital Español de Buenos Aires-Hospital de Alta complejidad en red “El Cruce”, Dr. Néstor Carlos Kirchner, Buenos Aires, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Cuidados Intensivos, Hospital Universitario HM Sanchinarro, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Emergencia, Hospital Universitario HM Sanchinarro, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Fundación de investigación HM Hospitales, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Unidad de Cuidados Intensivos, Hospital Nacional Profesor Alejando Posadas, Buenos Aires, Argentina" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "En respuesta a «Distrés respiratorio agudo secundario a la transfusión sanguínea»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We would like to thank the authors of the letter entitled “Acute respiratory distress secondary to blood transfusion” for their interest in our article.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> We agree with them that blood derivatives transfusion (whole blood cells, red cells, apheresis platelets, fresh frozen plasma, cryoprecipitates, stem cell products and endovenous inmunoglobulins) are well recognized, but infrequent, risk factors for Acute respiratory distress syndrome (ARDS).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> In the original manuscript,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> blood derivatives products and other ARDS risk factors are not mentioned because it is focused on what is required to define a “disease” and the relation between ARDS and diffuse alveolar damage (DAD). From our point of view, the effect of each risk factor in ARDS susceptibility or outcome should be clarified after the ARDS has been agreed upon as a disease (see below).</p><p id="par0010" class="elsevierStylePara elsevierViewall">Currently, given that it has been demonstrated that only half of ARDS patients present DAD<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,3</span></a> – which is considered the histological ARDS hallmark<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> – as well as the effect of DAD in the ARDS outcome,<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3,5</span></a> we consider that including DAD as an ARDS diagnosis criteria would increase the accuracy of the definition.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> If this proposal is accepted, the ARDS with DAD should be considered the real disease and the others (ARDS without DAD) as a misdiagnosis or mimic.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> This new interpretation determines that old paradigms and approaches should be changed.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In reference to the transfusion related acute lung injury (TRALI), firstly, its association with DAD is not well demonstrated, as because studies with pathological analysis are scarce and biased, due to the short time between the blood product administration and the deceased.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> Secondly, accepting that TRALI is risk factor for ARDS with DAD, it is unknown if the DAD induced by blood transfusion is similar to those induced by other risk factors. This fact could be of paramount importance because ARDS with DAD is a complex entity with several different physio-pathological pathways. For that reason, different subtypes of DAD would be recognized according to the processes which predominate (e.g. apoptosis, tight junction dysfunctions or alveolar clearance impairment). Finally, all of these pathological findings should be settled in a specific clinical context, in which differential clinical diagnosis, like transfusion associated circulatory overload (TACO), have been ruled out.</p><p id="par0020" class="elsevierStylePara elsevierViewall">As a conclusion, we recognize that blood transfusion derivatives can trigger episodes of severe respiratory insufficiency, but their relation to ARDS with DAD is still unknown. It is evident that improving the diagnosis accuracy seems to be an initial and basic requirement to enhance the efficacy and effectiveness of future treatment.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute respiratory distress: from syndrome to disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Cardinal-Fernandez" 1 => "E. Correger" 2 => "J. Villanueva" 3 => "F. 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| 2021 Abril | 54 | 130 | 184 |
| 2021 Marzo | 75 | 25 | 100 |
| 2021 Febrero | 54 | 38 | 92 |
| 2021 Enero | 44 | 32 | 76 |
| 2020 Diciembre | 40 | 22 | 62 |
| 2020 Noviembre | 26 | 21 | 47 |
| 2020 Octubre | 27 | 24 | 51 |
| 2020 Septiembre | 42 | 30 | 72 |
| 2020 Agosto | 29 | 25 | 54 |
| 2020 Julio | 38 | 28 | 66 |
| 2020 Junio | 38 | 27 | 65 |
| 2020 Mayo | 12 | 20 | 32 |
| 2020 Abril | 40 | 13 | 53 |
| 2020 Marzo | 17 | 15 | 32 |
| 2020 Febrero | 55 | 27 | 82 |
| 2020 Enero | 33 | 31 | 64 |
| 2019 Diciembre | 31 | 21 | 52 |
| 2019 Noviembre | 24 | 31 | 55 |
| 2019 Octubre | 27 | 18 | 45 |
| 2019 Septiembre | 29 | 25 | 54 |
| 2019 Agosto | 35 | 20 | 55 |
| 2019 Julio | 28 | 25 | 53 |
| 2019 Junio | 26 | 15 | 41 |
| 2019 Mayo | 54 | 39 | 93 |
| 2019 Abril | 30 | 18 | 48 |
| 2019 Marzo | 28 | 30 | 58 |
| 2019 Febrero | 25 | 31 | 56 |
| 2019 Enero | 24 | 40 | 64 |
| 2018 Diciembre | 37 | 32 | 69 |
| 2018 Noviembre | 85 | 46 | 131 |
| 2018 Octubre | 133 | 33 | 166 |
| 2018 Septiembre | 49 | 20 | 69 |
| 2018 Agosto | 35 | 23 | 58 |
| 2018 Julio | 37 | 26 | 63 |
| 2018 Junio | 57 | 19 | 76 |
| 2018 Mayo | 29 | 13 | 42 |
| 2018 Abril | 39 | 28 | 67 |
| 2018 Marzo | 60 | 37 | 97 |
| 2018 Febrero | 70 | 14 | 84 |
| 2018 Enero | 1 | 0 | 1 |
| 2017 Diciembre | 0 | 1 | 1 |
| 2017 Noviembre | 1 | 0 | 1 |
| 2017 Octubre | 3 | 3 | 6 |
| 2017 Septiembre | 4 | 1 | 5 |
| 2017 Julio | 0 | 2 | 2 |
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