Transfusion-related Acute Lung Injury (TRALI)

George H Roberts

doi:10.29074/ascls.17.3.133

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George H Roberts⇑

Address for correspondence: George H Roberts EdD CLS(NCA), Department of Clinical Laboratory Science and Radiologic Technology, The University of Louisiana at Monroe, 700 University Avenue, Monroe LA 71209-0440. (318) 342-1632, (318) 342-3256 (fax). groberts{at}ulm.edu

Extract

Transfusion is an inevitable event in the life of many individuals. Transfusion medicine personnel attempt to provide blood products that will result in a safe and harmless transfusion. However, this is not always possible since no laboratory test gives totally accurate and reliable results all the time and testing in routine transfusion services is devoted primarily to the identification of red blood cell problems. Thus, when patients are transfused, several possible adverse effects may occur in the transfused patient even though quality testing indicates no potential problem. These adverse events include infectious complications, hemolytic reactions, anaphylaxis, urticaria, circulatory overload, transfusion-associated graft-versus-host disease, chills and fever, immunomodulation, and transfusion-related acute lung injury (TRALI).¹

CASE HISTORY A 52-year-old white male was admitted to a local hospital emergency room (ER) for an acute upper gastrointestinal hemorrhage. He denied any other medical problems, took no medications, and stated that he did not smoke or drink alcohol. His admitting hemoglobin and hematocrit were 7.8 g/dL and 24%. He was referred by the ER physician to a gastroenterologist who performed an esophagogastro duodenoscopy (EGD) in the ER to determine the cause of the bleeding episode. During and immediately following the procedure, the patient received four units of compatible packed red blood cells (RBCs) and four units of fresh frozen plasma (FFP). His baseline vital signs were normal; however, following administration of approximately 125 mL of the fourth unit of FFP, he began to complain of nausea, chills, and difficulty breathing. The transfusion was immediately discontinued and…

ABBREVIATIONS: TRALI = transfusion related acute lung injury.