transfusion-related acute lung injury (TRALI)
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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
Pathology
- donor antibodies reacting with recipient leukocytes causing leukocyte aggregation in the pulmonary capillary bed
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
Laboratory
Radiology
Differential diagnosis
- transfusion-associated hypervolemia
- TRALI is not associated with volume overload[1]
Management
- supportive
- most patients recover within 1 week.
More general terms
References
- ↑ Jump up to: 1.0 1.1 1.2 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18. American College of Physicians, Philadelphia 2012, 2015, 2018.
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/19699017
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/25611652