CASE HISTORY – May 2018

Transfusion-related acute lung injury – TRALI

Authors: Ksenia Rumjantseva, Kadri Rohtla

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Abstract

TRALI is a rare, potentially life-threatening complication of the tranfusion of blood or plasma containing components Two cases of TRALI with favorouable outcome are presented.

Symptoms of TRALI typically develop during or within six hours of transfusion. Patients present with a rapid onset of dyspnea and tachypnea. There may be associated fever, cyanosis and hypotension. Clinical examination reveals hypoxemia and pulmorary crackles; chest X-ray shows evidence of bilateral pulmonary oedema. The symptoms are not associated with the volume overload or heart failure.The majority of patients require ventilatory and cardiac support. With supportive care lung injury is generally transient, blood oxygen level returning to normal levels within 48 to 96 hours and chest X-ray returning to normal within 96 hours.

Most TRALI cases are related to the presence of antihuman leucocyte and antihuman neutrofil antibodies in donor plasma.The most effective measure to mitigate the risk for TRALI is to collect all plasma containing components and whole blood for tranfusion from men and from women who have not been pregnant. All cases of TRALI or suspected TRALI events should be reported.