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The Drug-Induced Respiratory Disease Website and App

Hemotherapy (transfusion/infusion of whole blood, red cells, platelets, or blood products)

Essential reading at PMID 25959215. Transfusion of blood or components (platelets, plasma derivatives, FFP, IVIG, factor IX, cryoprecipitate) may produce among other complications the TRALI syndrome, a leading cause of morbidity and mortality from hemotherapy. A screen for anti-HLA and anti-HNA antibodies (usually from a multiparous donor) must be done in any TRALI case. TRALI needs be separated from transfusion-associated circulatory overload (TACO. See under II h) (Bloodborne infections are not covered here). Review at PMID 23642914. Indentified risk factors to review before deciding transfusion (PMID: 24673344)

Frequency - Incidence

Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

I - Interstitial/parenchymal lung disease

I.l

Diffuse alveolar damage (DAD) (see alsoo under IIb and XVf)
I.y

Progression, acceleration or exacerbation of preexisting ILD/fibrosis

II - Pulmonary edema - Acute lung injury - ARDS

II.a

Pulmonary edema, noncardiogenic (NCPE)
II.b

ARDS - Acute lung injury
II.e

Transfusion-related acute lung injury (TRALI) (May cause ARDS)
II.f

Hypoxemia, low oxygen saturation (may occur in isolation)
II.h

Overload pulmonary edema (including posttransfusional (TACO))

III - Pulmonary/alveolar/airway hemorrhage/bleeding

III.a

Alveolar hemorrhage (AH), diffuse AH (DAH)

VI - Pulmonary vasculopathy

VI.a

Pulmonary embolism - Venous thrombosis/thromboembolism
VI.i

Acute pulmonary hypertension
VI.n

Crystal pulmonary embolism

VIII - Central-large-upper airway (incl. pharyngeal-nasal) involvement

VIII.a

Angioedema (may cause UAO, asphyxia and death)

X - Systemic/Distant conditions, syndromes and reactions

X.f

Anaphylaxis-Anaphylactoid reaction (can be fatal)

XI - Miscellaneous

XI.b

Chest pain (acute or subacute), lone or prominent
XI.d

Metabolic acidosis (incl. lactic acidosis/-gap). May cause hyperpnea/dyspnea
XI.n

Neutropenia, agranulocytosis (w/wo infection/sepsis)

XII - Cardiovascular involvement / toxicity

XII.j

Myocardial stunning
XII.n

Cardiovascular collapse - Cardiogenic shock - Hypotension

XV - Pathology

XV.g

Path: Alveolar hemorrhage (see also IIIa)
XV.w

Path: Pulmonary edema (see also II/IIa)
XV.aj

Path: Cholesterol crystal embolism
XV.at

Path: Pulmonary capillary granulocyte sequestration

XVI - Imaging

XVI.d

Imaging: Alveolar opacities or haze with a batwing or butterfly distribution

XVII - Infections & related conditions

XVII.ad

Systemic infection (transmitted)