II. Epidemiology
- Leading cause of transfusion associated mortality
III. Pathophysiology
-
Acute Pulmonary Edema (non-hydrostatic, non-cardiogenic) within 6 hours of transfusion (non-cardiac)
- Results from immune mediated Neutrophil activation, endothelial injury, and capillary leak
- Acute Lung Injury is a result of exudative fluid extravasation
- Associated with ANCA and HLA Antibody mediated lung injury
- May be associated with plasma donated by Multiparous women
- Results from preformed WBC antibodies against paternal Antigens
IV. Causes
- Platelet Transfusion (1 in 100,000 units transfused)
- Red Blood Cell Transfusion (0.5 per 100,000 units transfused)
- Plasma Transfusion (0.4 per 100,000 units transfused)
V. Signs
- Fever and chills
- Dyspnea
- Tachypnea
- Tachycardia
- Hypoxemia
- Altered Blood Pressure
VI. Imaging
- Chest XRay with bilateral Pulmonary Infiltrates
VII. Differential Diagnosis
- See Transfusion Complication
- See Dyspnea
- Acute Respiratory Distress Syndrome (ARDS)
- Cardiogenic Shock or Congestive Heart Failure
- Transfusion-Associated Circulatory Overload (TACO)
- TACO presents with Peripheral Edema, Jugular Venous Distention and increased BNP
- These Cardiogenic Pulmonary Edema causes are typically absent in TRALI
VIII. Management
- Immediately discontinue transfusions
- Supportive care
- Manage in similar fashion as Acute Respiratory Distress Syndrome (ARDS)
- Measures that have not been shown effective
IX. Prevention
- Avoid Multiparous female donors for Blood Products (esp. for Platelet Transfusion)
X. Resources
- FDA: TRALI
- Cho (2019) StatPearls, accessed 7/1/2020