Transfusion-associated lung injury (TRALI): Review
You knew it was uncommon, but the stats might surprise you
Transfusion-associated lung injury (TRALI) is a form of non-cardiogenic pulmonary edema and acute hypoxemic respiratory failure (PaO2/FiO2 <300) that develops during or soon after transfusion with blood products. It thus can also be thought of as acute respiratory distress syndrome (ARDS) precipitated by transfusion.
The diagnosis of TRALI is clinical: there is no laboratory or other testing for TRALI (beyond a chest radiograph).
TRALI is the second-most common cause of transfusion-related death, after transfusion-associated circulatory overload (TACO). But thanks to the safety of the blood supply—in particular, the mitigation strategies in place to prevent transfusion reactions—TRALI occurs rarely.
TRALI is theorized to occur commonly in the ICU, although there’s little evidence to support this.
After stopping any blood transfusion in process, TRALI is generally treated with supportive care. Corticosteroids are considered a reasonable therapy for ARDS, of which TRALI is a cause.
How O…
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