Transfusion-related acute lung injury
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| Transfusion-related acute lung injury | |
|---|---|
| Hyaline membranes in the lung | |
| Synonyms | TRALI |
| Pronounce | N/A |
| Specialty | Hematology, Pulmonology |
| Symptoms | Dyspnea, hypoxemia, fever, hypotension |
| Complications | N/A |
| Onset | Within 6 hours of blood transfusion |
| Duration | Usually resolves within 48 to 96 hours |
| Types | N/A |
| Causes | Antibody-mediated reaction to donor leukocytes |
| Risks | Multiple transfusions, pregnancy, surgery |
| Diagnosis | Clinical, based on symptoms and timing relative to transfusion |
| Differential diagnosis | Transfusion-associated circulatory overload, acute respiratory distress syndrome |
| Prevention | Use of leukoreduced blood products, screening donors for HLA antibodies |
| Treatment | Supportive care, oxygen therapy, mechanical ventilation if needed |
| Medication | N/A |
| Prognosis | Generally good with appropriate management |
| Frequency | Estimated 1 in 5,000 transfusions |
| Deaths | N/A |
Transfusion-related acute lung injury (TRALI) is a serious complication of blood transfusion characterized by the acute onset of respiratory distress and non-cardiogenic pulmonary edema. It is considered one of the leading causes of transfusion-related mortality.
Pathophysiology[edit]
TRALI is thought to be caused by the interaction of transfused blood components with the recipient's immune system. The condition is often associated with the presence of antibodies in the donor plasma that react with the recipient's leukocytes, leading to the activation of these cells and the release of inflammatory mediators. This results in increased permeability of the pulmonary capillaries and subsequent pulmonary edema.
Clinical Presentation[edit]
Patients with TRALI typically present with acute respiratory distress within 6 hours of transfusion. Symptoms include dyspnea, hypoxemia, and bilateral infiltrates on chest X-ray, which are indicative of pulmonary edema. Fever and hypotension may also be present.
Diagnosis[edit]
The diagnosis of TRALI is primarily clinical, based on the sudden onset of respiratory symptoms following transfusion and the exclusion of other causes of acute lung injury. A chest X-ray is used to confirm the presence of pulmonary edema.
Management[edit]
The management of TRALI is largely supportive, focusing on maintaining adequate oxygenation and hemodynamic stability. Mechanical ventilation may be required in severe cases. It is crucial to discontinue the transfusion immediately upon suspicion of TRALI.
Prevention[edit]
Preventive strategies for TRALI include the use of plasma from male donors or female donors who have never been pregnant, as these donors are less likely to have antibodies that can cause TRALI. Additionally, leukoreduction of blood products may reduce the risk.
Epidemiology[edit]
TRALI is a rare but serious complication, with an estimated incidence of 1 in 5,000 transfusions. It is more commonly associated with plasma-rich blood products such as fresh frozen plasma and platelets.
