Transfusion-related acute lung injury(TRALI)

Transfusion-related acute lung injury(TRALI) is one of the most severe transfusion reactions. According to the FDA, TRALI is thought to be the third leading cause of transfusion related death. 

What is TRALI?
Transfusion-related acute lung injury(TRALI) is defined as acute dyspnoea with hypoxia and bilateral pulmonary infiltrates during or within 6 hours of transfusion, in the absence of circulatory overload or other likely causes, or in the presence of human leucocyte antigen (HLA) or human neutrophil antigen(HNA) antibodies cognate with the recipient.

How can TRALI be diagnosed?
1. No evidence of acute lung injury(ALI)prior to transfusion
2. ALI onset during or within 6 hours of cessation of transfusion
3. Hypoxemia defined by any of these methods:
  PaO2/FiO2 less than or equal to 300mmHg
  Oxygen saturation less than 90% on room air
  other clinical evidence
4. Radiographic evidence of bilateral infiltrates
5. No evidence of left atrial hypertension(i.e., circulatory overload)

How to treat TRALI?
First, the patients who are diagnosed or suspected for TRALI should stop transfusion. Patients with mild symptoms can be given support treatment. Patients with severe symptoms are assisted by ventilator therapy.

How about the prognosis of TRALI?
The prognosis of TRALI is better than ARDS. Serious complications or death can occur in severe cases, and the cause of death is usually multiple organ failure by severe hypoxemia.
It is crucial to the treatment and prognosis of TRALI patients that clinicians improve their understanding of TRALI, timely detection and rapid diagnosis and appropriate treatment. 
Edited and translated by Jie Sun

Translation edited by Kurt Lee