Transfusion-related acute lung injury

A serious complication of blood transfusion

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

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

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

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.

Hyaline membranes in the lung, a histological feature associated with acute lung injury.

Chest X-ray showing bilateral infiltrates consistent with TRALI.

Management

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

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

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.

Related pages

• Blood transfusion
• Acute respiratory distress syndrome
• Non-cardiogenic pulmonary edema

Transfusion-related acute lung injury

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  Hyaline membranes at very high magnification

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  Transfusion-related acute lung injury chest X-ray