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
Images: Related links to external sites (from Bing)
Related Studies
Concepts | Disease or Syndrome (T047) |
SnomedCT | 389078002 |
Italian | Traumatismo polmonare acuto correlato a trasfusione, TRALI |
Japanese | 輸血関連急性肺障害, ユケツカンレンキュウセイハイショウガイ, TRALI, TRALI |
Spanish | lesión aguda de pulmón relacionada con transfusión, LPART, Lesión pulmonar aguda relacionada con transfusión, lesión aguda de pulmón relacionada con transfusión (trastorno), lesión traumática aguda de pulmón relacionada con transfusión (trastorno), lesión traumática aguda de pulmón relacionada con transfusión |
French | TRALI (Syndrome de détresse respiratoire aiguë post-transfusionnel), Lésion aiguë du poumon liée à la transfusion |
Dutch | TRALI, transfusiegerelateerd acuut longletsel |
Portuguese | LGPLT (Lesão grave do pulmão ligada à transfusão), Lesão traumática pulmonar aguda relacionada com transfusão |
German | TRALI-Syndrom, transfusionsbedingte akute Lungenverletzung |
Czech | Akutní plicní poranění v souvislosti s transfúzí, TRALI |
Hungarian | Transzfúzióval összefüggő akut tüdőkárosodás, TRALI |
English | Transfusion-related acute lung injury, TRALI, Transfusion related acute lung injury (disorder), Transfusion related acute lung injury |