Becky Piper, MN RNPierce College

Nursing Program

Transfusion Related Acute Lung Injury:

A Simulation Case Experience For Nurse Educators

Objectives

Provide a brief overview of transfusion reactions

Provide a definition of TRALI Describe the steps used to build the

TRALI SCE

TRALI

TRALI defined Pathophysiology

4 primary causes1. HNA/HLA antibodies2. Multiparous donors

(>3pregnancies)3. Lipid priming agents from older

PRBC products4. First hit-second hit model

TRALI Fatalities

010203040506070

8090

100

1996 1998 2000 2002 2004

TRALI Fatalities

Total TransfusionFatalities Reported

Recent Trends TRALI

0

5

10

15

20

25

30

35

40

FY 2005 FY 2006

TRALITACO

Deaths

TRALI vs. TACO Comparison TRALI TACO

Blood Pressure

Hypotension Hypertension

Onset Up to six hrs post transfusion

Usually occurs during or immediately after a transfusion

Chest X-Ray Bilateral pulmonary infiltrates, normal heart

Bilateral pulmonary infiltrates, enlarged heart

Lab tests BNPTNI

<250pg/ml Normal

>250 pg/ml Elevated

TRALI vs. Normal Lung

Treatment

Symptoms may be mild to severe If severe may need intubation to

support respiratory system - treatment in ICU

Use of steroids Lasix (Furosimide) is NOT appropriate

Symptoms may subside within 96 hrs.

Knowledge Gaps

Lack of information on TRALI for nurses and transfusionists in peer review journals

Few nursing text books mention it!

Building the TRALI Simulation

Research – TRALI and Simulation in Nursing

Writing the simulation using UWSON template

First review by Simulation experts at UWSON

Review by two Medical DirectorsDr. Tom Baker, Cascade Regional

Blood Services – Tacoma Dr. Bob Ranlett, Inland Blood

Centers - Spokane Trial runs for debugging

TRALI Case Study

Case Description: Your patient is Lucy Leardal, a 72 yr

old female who tripped over her cat and was subsequently admitted in the evening through the Emergency Room with a left hip fracture. Lucy has a history of A-Fib and takes 5 mg of Coumadin daily.

TRALI Case study

You have just come out of shift report. Your patient is scheduled for hip surgery tomorrow

(ORIF). She is receiving the first of three units of FFP ordered to reverse the effects of Coumadin prior to the surgery. She has received approximately 50 ml of the first unit of FFP.

References Fatalities reported to FDA , Annual summary for fiscal

years 2005 and 2006http://www.fda.gov/cber/blood/fatal0506.htm

Bradley, P. (2006). The history of simulation in medical education and possible future directions. Medical Education, (40), 254-262.

Issenberg, S.B., McGaghie, W., Petrusa, E., Gordon, D. & Scalese, R. , (2005). Features and uses of high fidelity medical simulation that lead to effective learning: a BEME systematic review. Medical Teacher,(27) 1, 10 - 28.

Jeffries, P.R., (Ed.), (2007). Simulation in Nursing Education, New York: National League for Nursing.

Perkins, G. (2007). Simulation in resuscitation training.

Resuscitation, (73), 202-211.