The daily educational pearl – TRALI

Transfusion related lung injury (TRALI)

= acute dyspnoea with hypoxia and bilateral pulmonary infiltrates during or within 6 hours of transfusion, not due to circulatory overload or other likely cause

– cause not very clear, but potentially antibodies to white cell antigens or other neutrophil priming agents

Clinical features:

required by definition to diagnose TRALI:
– onset within 6 hours of transfusion
– bilateral infiltrates on CXR
– hypoxia

other:
– hypotension
– fever

 Who is at risk?

– risk 7 times higher with plasma-rich components (eg FFP, platelets)
– patients who receive bloods products from female donors, with previously pregnant female donors as highest risk

Management
– supportive – ventilation / inotropes for hypotension

– preferentially plasma from male donors used for FFP / platelets

All suspected reactions should be reported to the blood bank.

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2 thoughts on “The daily educational pearl – TRALI

  1. Interesting. I wonder how often we miss patients with TRALTI thinking it’s simply fluid overload? I assume TRALI is fairly uncommon.

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    • It is fairly uncommon, they say the incidence is 1/2,500 – 1/5,000 transfusions. And quite often these patients don’t have the best hearts and/or have other reasons to develop ARDS. But I guess it’s useful to be aware of it.

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