CARTAS
AL
DIRECTOR
445
En
Inglaterra,
de
las
93
muertes
relacionadas
con
la
trans-
fusión
entre
2010
y
2015,
el
55%
fueron
por
DRA
asociadas
a
la
TSA:
39
S-EPC,
9
LPART
y
3
DAT.
Por
todo
ello,
así
como
por
la
importancia
clínica,
por
el
impacto
sanitario
y
por
la
trascendencia
terapéutica,
consideramos
ineludible
contemplar
en
este
documento
los
episodios
de
DRA
asociados
a
la
transfusión
sanguínea,
recor-
damos
la
obligación
de
notificar
todos
los
cuadros
al
sistema
de
hemovigilancia,
así
como
que
«
una
unidad
puede
ser
suficiente
»
.
Conflicto
de
intereses
Ninguno
para
este
trabajo.
El
Dr.
García
Erce
ha
impartido
charlas
y
moderado
mesas
en
congresos
y
jornadas
con
becas
o
financiación
de
Vifor-
Espa
̃
na,
Sandoz,
Amgen,
Alexion,
Braun,
GSK,
Octapharma,
Novartis
y
Sanofi.
Agradecimientos
A
aquellos
centros
de
transfusión
que
nos
consiguen
los
mejores
y
más
frescos
componentes
sanguíneos.
Bibliografía
1.
Cardinal-Fernández
P,
Correger
E,
Villanueva
J,
Rios
F.
Acute
respiratory
distress:
From
syndrome
to
disease.
Med
Intensiva.
2016;40:169---75.
2.
A
̃
nón
JM,
García
de
Lorenzo
A,
Quintana
M,
González
E,
Brus-
cas
MJ.
Transfusion-related
acute
lung
injury.
Med
Intensiva.
2010;34:139---49
[artículo
en
espa
̃
nol].
3.
Lopez
Saubidet
I,
Maskin
LP,
Rodríguez
PO,
Bonelli
I,
Set-
ten
M,
Valentini
R.
Mortality
in
patients
with
respiratory
distress
syndrome.
Med
Intensiva.
2016;40:356---63
[consul-
tado
en
enero
2017].
Disponible
en:
http://www.shotuk.org/
wp-content/uploads/SHOT-2015-Annual-Report-Web-Edition-
Final-bookmarked.pdf
4.
Comité
Científico
para
la
Seguridad
Transfusional
(CCST).
Lesión
pulmonar
aguda
relacionada
con
la
transfusión
(LPART/TRALI):
Medidas
de
prevención
[consultado
enero
2017].
Disponible
en:
http://www.msssi.gob.es/profesionales/saludPublica/
medicinaTransfusional/acuerdos/docs/lesion
Pulmonar
Aguda.
pdf
5.
García
Erce
JA,
Usón
C,
Menéndez
Jándula
B,
Mu
̃
noz
Gómez
M.
Patient
blood
management:
Reduction
of
blood
transfusion,
was-
tage
and
costs.
Hematologica.
2016;101
supl4:1---376.
J.A.
García
Erce
a
,
b
,
c
,
∗
y
M.
Quintana
Díaz
d
,
e
,
f
a
Banco
de
Sangre
y
Tejidos
de
Navarra,
Pamplona,
Espa
̃
na
b
Instituto
Aragonés
de
Ciencias
de
la
Salud
(IACS),
IdiPAZ49,
Zaragoza,
Espa
̃
na
c
Grupo
de
Trabajo
de
la
SETS
Hemoterapia
basada
en
el
sentido
común
d
Departamento
de
Medicina,
Universidad
Autónoma
de
Madrid,
Madrid,
Espa
̃
na
e
Servicio
de
Medicina
Intensiva,
Hospital
Universitario
La
Paz,
IdiPAZ,
Madrid,
Espa
̃
na
f
Grupo
de
Trabajo
de
Hemoderivados,
SEMICYUC,
Madrid,
Espa
̃
na
∗
Autor
para
correspondencia.
Correo
electrónico:
jagarciaerce@gmail.com
(J.A.
García
Erce).
http://dx.doi.org/10.1016/j.medin.2017.01.013
0210-5691/
©
2017
Elsevier
Espa
̃
na,
S.L.U.
y
SEMICYUC.
Todos
los
derechos
reservados.
In
reply
to
‘‘Acute
respiratory
distress
secondary
to
blood
transfusion’’
En
respuesta
a
«
Distrés
respiratorio
agudo
secundario
a
la
transfusión
sanguínea
»
Dear
Editor,
We
would
like
to
thank
the
authors
of
the
letter
entitled
‘‘Acute
respiratory
distress
secondary
to
blood
transfu-
sion’’
for
their
interest
in
our
article.
1
We
agree
with
them
that
blood
derivatives
transfusion
(whole
blood
cells,
red
cells,
apheresis
platelets,
fresh
frozen
plasma,
cryoprecipi-
tates,
stem
cell
products
and
endovenous
inmunoglobulins)
are
well
recognized,
but
infrequent,
risk
factors
for
Acute
respiratory
distress
syndrome
(ARDS).
2
In
the
original
manuscript,
1
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).
Currently,
given
that
it
has
been
demonstrated
that
only
half
of
ARDS
patients
present
DAD
1,3
---
which
is
considered
the
histological
ARDS
hallmark
4
---
as
well
as
the
effect
of
DAD
in
the
ARDS
outcome,
3,5
we
consider
that
including
DAD
as
an
ARDS
diagnosis
criteria
would
increase
the
accuracy
of
the
definition.
1
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.
6
This
new
interpre-
tation
determines
that
old
paradigms
and
approaches
should
be
changed.
In
reference
to
the
transfusion
related
acute
lung
injury
(TRALI),
firstly,
its
association
with
DAD
is
not
well
demons-
trated,
as
because
studies
with
pathological
analysis
are
scarce
and
biased,
due
to
the
short
time
between
the
blood
product
administration
and
the
deceased.
7
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