Transfusion-related acute lung injury (TRALI) is a rare but potentially fatal complication of blood product transfusion. TRALI has been defined by both a National Heart, Lung, and Blood Institute (NHLBI) working group as well as a Canadian Consensus Conference, as new acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) occurring during or within six hours after blood product administration ( table 1 ) [ 1,2 ]. When a clear temporal relationship to an alternative risk factor for ALI/ARDS coexists, a formal diagnosis of TRALI cannot be made. In these circumstances, the diagnostic terminology to be used is either "possible TRALI" or the more recently endorsed term "transfused ARDS" [ 3 ].
4. A. Inhaled steroids are the treatment of choice for mild persistent asthma. For intermittent asthma, the use of a short-acting inhaler like albuterol, Choice (B), is okay. But after someone begins to have more frequent asthma exacerbations, using an inhaled steroid is recommended. The key word here is persi s tent. Choice (C), methacholine, can be used to test for asthma, not to treat it. Ipratropium bromide (Atrovent), Choice (D), is used in the treatment of COPD. Nebulized albuterol and Atrovent together, Choice (E), are used in the treatment of advanced COPD — many patients actually have their own nebulizers.
Patients were excluded if they had a history of severe reactions to blood or any blood-derived product; if they had a selective IgA deficiency or demonstrable antibodies to IgA; if they received blood or any blood product or derivative other than a commercially available IGIV within 3 months prior to study entry; if they had hepatic function abnormalities or a positive direct Coombs test at screening; if they had a pre-existing renal impairment, a history of drug or alcohol abuse in the previous 12 months or acquired medical condition known to cause secondary immune deficiency; if they were receiving long-term daily treatment with steroids at a dose of at least 1 mg/kg/day; if they had a requirement for pre-medication for IGIV infusion other than aspirin, acetaminophen, or other non-steroidal anti-inflammatory drug, or antihistamine; and if the received immunosuppressive or immunomodulatory drugs.