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To the Editor: Dr Vincent and colleagues¹ found that patients in the intensive care unit (ICU) who received transfusions were also at higher risk of mortality, and that this difference persisted even after accounting for differing degrees of organ dysfunction. Neither the authors nor Drs Hébert and Fergusson² in the accompanying Editorial discuss transfusion-related acute lung injury (TRALI) as an explanation for the increased mortality among those who received transfusions. The true incidence of TRALI is unknown, but it is considered to be one of the most common but most underdiagnosed adverse effects of transfusion, particularly in its milder presentations.³ We believe that future research on the clinical consequences of blood transfusion should consider this important and, until recently, overlooked complication of blood transfusion.

The letters of Dr Karkouti and colleagues, and of Mr Rathore and Dr Krumholz, were shown to Dr Vincent and colleagues and to Drs Hébert and Fergusson. Both groups of authors declined to respond to both letters.—ED.

Keyvan Karkouti, MD; W. Scott Beattie, MD; Duminda N. Wijeysundera, MD; Stuart A. McCluskey, MD
Departments of Anesthesia and Health Policy, Management, and Evaluation
University of . . . [Full Text of this Article]

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