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Transfusion-Related Acute Lung Injury

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Transfusion-Related Acute Lung Injury, Transfusion Associated Acute Lung Injury, TRALI

  • See Also
  1. Transfusion Complication
  2. Transfusion Associated Circulatory Overload (TACO)
  • Epidemiology
  1. Leading cause of transfusion associated mortality
  • Pathophysiology
  1. Acute Pulmonary Edema (non-hydrostatic, non-cardiogenic) within 6 hours of transfusion (non-cardiac)
    1. Results from immune mediated Neutrophil activation, endothelial injury, and capillary leak
    2. Acute Lung Injury is a result of exudative fluid extravasation
  2. Associated with ANCA and HLA Antibody mediated lung injury
  3. May be associated with plasma donated by Multiparous women
    1. Results from preformed WBC antibodies against paternal Antigens
  • Causes
  1. Platelet Transfusion (1 in 100,000 units transfused)
  2. Red Blood Cell Transfusion (0.5 per 100,000 units transfused)
  3. Plasma Transfusion (0.4 per 100,000 units transfused)
  • Signs
  1. Fever and chills
  2. Dyspnea
  3. Tachypnea
  4. Tachycardia
  5. Hypoxemia
  6. Altered Blood Pressure
  • Imaging
  1. Chest XRay with bilateral Pulmonary Infiltrates
  • Differential Diagnosis
  1. See Transfusion Complication
  2. See Dyspnea
  3. Acute Respiratory Distress Syndrome (ARDS)
  4. Cardiogenic Shock or Congestive Heart Failure
  5. Transfusion-Associated Circulatory Overload (TACO)
    1. TACO presents with Peripheral Edema, Jugular Venous Distention and increased BNP
    2. These Cardiogenic Pulmonary Edema causes are typically absent in TRALI
  • Management
  1. Immediately discontinue transfusions
  2. Supportive care
  3. Manage in similar fashion as Acute Respiratory Distress Syndrome (ARDS)
  4. Measures that have not been shown effective
    1. Corticosteroids or Immunosuppressants
    2. Diuretics
  • Prevention
  1. Avoid Multiparous female donors for Blood Products (esp. for Platelet Transfusion)
  • Resources
  1. FDA: TRALI
    1. https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/transfusion-related-acute-lung-injury-trali
  2. Cho (2019) StatPearls, accessed 7/1/2020
    1. https://www.ncbi.nlm.nih.gov/books/NBK507846/
  • References
  1. Raval (2020) Am Fam Physician 102(1):30-8 [PubMed]
  2. Sharma (2011) Am Fam Physician 83(6): 719-24 [PubMed]