Contents

Search

transfusion-related acute lung injury (TRALI)

Etiology: - generally occurs after multiple transfusions - transfusion of packed red blood cells, platelet units, or fresh frozen plasma - can occur with any blood product that may contain even small amounts of plasma Epidemiology: - 1% of transfused post-surgical patients Clinical manifestations: - generally occurs within 6 hours of transfusion - dyspnea, hypoxia, - fever, chills, hypotension in 1/3 of patients [1] - resembles non-cardiac pulmonary edema Pathology: - donor antibodies reacting with recipient leukocytes causing leukocyte aggregation in the pulmonary capillary bed Laboratory: - pulse oximetry & arterial blood gas: hypoxia Radiology: - chest X-ray shows pulmonary infiltrates Differential diagnosis: - transfusion-associated hypervolemia - TRALI is not associated with volume overload [1] Management: - supportive - most patients recover within 1 week.

General

acute respiratory distress syndrome; acute lung injury (ARDS, ALI) blood transfusion reaction

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18. American College of Physicians, Philadelphia 2012, 2015, 2018.
  2. Silliman CC, Fung YL, Ball JB, Khan SY. Transfusion-related acute lung injury (TRALI): current concepts and misconceptions. Blood Rev. 2009 Nov;23(6):245-55. PMID: 19699017
  3. Brett AS Incidence of Transfusion Complications in Noncardiac Surgery Patients. NEJM Journal Watch. Jan 13, 2015 Massachusetts Medical Society (subscription needed) http://www.jwatch.org - Clifford L et al. Characterizing the epidemiology of postoperative transfusion- related acute lung injury. Anesthesiology 2015 Jan; 122:12. PMID: 25611652