TRALI

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One of the most common causes of of transfusion-related mortality or severe morbidity in developed countries.

Pathogenesis

2 major theories - due to passive infusion of:

• anti-leucocyte antibodies or
• blood storage-related lipids

Clinical features

For research purposes the diagnosis of TRALI requires exclusion of all other causes of acute lung injury. Clearly in clinical practice TRALI may co-exist with lung injury due to other processes.

• respiratory distress within first 2-6 hours after initiation of relevant blood transfusion
  • onset often abrupt
  • virtually all patients require supplemental oxygen
  • ~70% require mechanical ventilation
• hypotension in majority of patients but hypertension may occur
• fever very common
• ± transient neutropaenia
• absence of signs of circulatory overload
• resolution within 24-28 hours usual

Differential diagnosis

• acute lung injury from other causes
• cardiogenic pulmonary oedema
• fluid overload
• anaphylaxis
• pulmonary disease

Treatment

• Supportive
• No evidence of benefit from diuretics

Prognosis

Morality ~10%

Further reading

Moore SB. Transfusion-related acute lung injury (TRALI): clinical presentation, treatment and prognosis. Crit Care Med, 2006; 34 (5 suppl):S114-7

©Charles Gomersall, October, 2009 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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