TRALI is a clinical diagnosis Suspect TRALI when new ALI develops during or within six hours of transfusion Rule out other ALI risk factors such as sepsis and aspiration TRALI has been associated with all blood components that contain plasma Transfusion of even part of one unit has been associated with TRALIPractice points
Although the association of transfusion with lung injury has been observed for almost 30 years, the mechanisms are still unclear. In massive transfusion, the mechanism of lung injury was initially thought to be microaggregates in stored blood causing micro-pulmonary emboli and lung damage, but this theory has been discredited, since transfusion of stored blood through microaggregate filters has not prevented lung injury in animals15 nor in humans.16, 17 Pathologically, the disease involves
The actual incidence of TRALI is unknown because of lack of large, current prospective studies that use a standard definition for the syndrome. The lack of such studies account for the wide range in the reported incidence of TRALI, from approximately 1 in 500 to 1 in 100,000, as reviewed at the consensus conference in Toronto in 2004, including series from University of Denver, University of Alberta, Mayo Clinic, UK, and Canada.50 TRALI has been reported following transfusion of all
Stop the transfusion immediately if TRALI is suspected. Obtain a white blood cell count and chest radiograph. Request Blood Bank to quarantine other units from the same donation(s). Request other units for transfusion if indicated (no special requirements). Follow institutional polices for a transfusion reaction workup. Return bags of units of blood transfused in the last 6 hours, indicating the last unit transfused prior to onset of signs or symptomsPractice points
Patients with TRALI present with
TRALI is clinically defined as new ALI that develops during or within hours of transfusion of any blood product. In the absence of another ALI risk factor such as sepsis, pneumonia or aspiration, and when onset clearly develops after the transfusion, the diagnosis is clear. However in the presence of another ALI risk factor, the new ALI may be caused by the transfusion and/or the ALI risk factor. The mechanism of TRALI is unclear and may be multifactorial, including donor and recipient factors.
This work was supported by a Public Health Service grant P50 HL081027 from the National Heart Lung and Blood Institute, National Institutes of Health, USA.
Between 70% and 90% of patients who develop TRALI require ventilation, and mortality rates range from 5% to 25%.14,21 The National Blood Collection and Utilization survey reported TRALI occurred 1 in every 64,000 transfused components and approximately 0.01%-1.12% per product; however, other estimates range from 1 in 500 to 1 in 100,000.17,24 RBCs are frequently implicated in a TRALI transfusion reaction.25
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