Abstract
Administration of a large amount of fresh frozen plasma (FFP) is commonly required during massive bleeding because of the low concentration of fibrinogen in FFP. Transfusing high volumes of FFP involves a high risk of transfusion-associated circulatory overload (TACO). Here we report a case of acute lung injury associated with massive transfusion during cardiac surgery with cardiopulmonary bypass (CPB). A 78-year-old woman (height 146 cm, weight 45.3 kg) who had distal arch aortic aneurysm, aortic regurgitation, and angina pectoris underwent replacement of the aortic arch and aortic valve as well as coronary artery bypass graft surgery. After weaning off CPB, we administered 46 units of red blood cell concentrate, 40 units of FFP, and 60 units of platelet concentrate to stop uncontrolled bleeding. Although the patient was extubated on postoperative day 1, she presented with dyspnea and hypoxemia requiring the use of non-invasive positive pressure ventilation and high-flow nasal oxygen. A chest X-ray demonstrating pulmonary edema with bilateral effusions raised the suspicion of TACO. The use of cryoprecipitate and/or concentrated fibrinogen formulation is a potential option to prevent postoperative TACO and achieve rapid hemostasis.
