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Transfusion-Related Acute Lung Injury
Aka: Transfusion-Related Acute Lung Injury, Transfusion Associated Acute Lung Injury, TRALI
- See Also
- Transfusion Complication
- Transfusion Associated Circulatory Overload (TACO)
- Epidemiology
- Leading cause of transfusion associated mortality
- 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
- 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)
- Signs
- Fever and chills
- Dyspnea
- Tachypnea
- Tachycardia
- Hypoxemia
- Altered Blood Pressure
- Imaging
- Chest XRay with bilateral Pulmonary Infiltrates
- 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
- Management
- Immediately discontinue transfusions
- Supportive care
- Manage in similar fashion as Acute Respiratory Distress Syndrome (ARDS)
- Measures that have not been shown effective
- Corticosteroids or Immunosuppressants
- Diuretics
- Prevention
- Avoid Multiparous female donors for Blood Products (esp. for Platelet Transfusion)
- Resources
- FDA: TRALI
- https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/transfusion-related-acute-lung-injury-trali
- Cho (2019) StatPearls, accessed 7/1/2020
- https://www.ncbi.nlm.nih.gov/books/NBK507846/
- References
- Raval (2020) Am Fam Physician 102(1):30-8 [PubMed]
- Sharma (2011) Am Fam Physician 83(6): 719-24 [PubMed]