Transfusion-related acute lung injury: Definition and review

Abstract

Using the definition in this report, clinicians can diagnose and report TRALI cases to the blood bank; importantly, researchers can use this definition to determine incidence, pathophysiology, and strategies to prevent this leading cause of transfusion-associated mortality.

The incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of cardiac surgery patients: a prospective nested case-control study

“…5 Data on preoperative blood values and perioperative data were extracted from the electronic patient data system as well as ventilation time, hospital stay, and mortality. The European System for Cardiac Operative Risk Evaluation (EUROscore) and American Association of Anesthesiology (ASA) score were preoperatively scored by the cardiac surgeon and anesthesiologist, respectively.…”

“…28 Possible TRALI was defined using the consensus definition of TRALI (new onset hypoxemia or deterioration demonstrated by arterial oxygen tension/fraction of inspired oxygen Ͻ 300 mmHg, within 6 hours after transfusion, with bilateral pulmonary changes, in the absence of elevated left atrial pressure defined as a pulmonary arterial occlusion pressure less than or equal to 18 mmHg). 1,3,5 Chest radiographs were routinely taken before surgery and on arrival at the ICU and scored for the presence of new onset bilateral interstitial abnormalities by 2 independent physicians blinded to the predictor variables. When interpretation differed, chest radiograph and the description by the radiologist were reviewed to receive consensus.…”

“…[1][2][3][4] TRALI is defined as the acute onset of hypoxia and bilateral pulmonary infiltrates, in temporal relation to a blood transfusion. 1,5 Although the absence of specific disease markers and diagnostic tests has resulted in a large variation in estimations of incidence, 1,[6][7][8][9][10][11][12][13][14] TRALI is generally considered to be a rare event. However, TRALI is underdiagnosed and under-reported.…”

Transfusion-Related Acute Lung Injury (TRALI) Following Urological Surgery-Alarming Reaction: A Case Report

“…Before blood transfusion, she was alert, oriented with no cardiorespiratory abnormality on clinico-radiological evaluation. Her vital parameters were normal and total leukocyte count was 8700/ mm [3] with serum creatinine of 2 mg%.…”

“…Despite being the third leading cause of transfusion-related death, it is usually underdiagnosed and under reported [2]. It is defined as acute lung injury that occurs after transfusion of all types of blood products including whole blood, platelets, fresh frozen plasma, cryoprecipate, granulocytes, stem cell products and even IV immunoglobulin preparations [3][4][5][6][7] occurring within the first six hours following a transfusion [3]. There are some case reports with even packed red blood cell since there is some residual plasma in the packed cells also.…”