TRANSFUSION ASSOCIATED LUNG INJURY

TRALI IS A RARE  COMPLICATION FOLLOWING BLOOD TRANSFUSION. THE ESTIMATED INCIDENCE IS  1:5000. ANY EPIDSODE  OF ACUTE RESPIRATORY FAILURE FOLLOWING TRANSFUSION CAN BE  CATEGORISED AS TRALI. SINGLE TRANSFUSION IS ENOUGH TO TRIGGER THE REACTION

PATHOPHYSIOLOGY: Anti Leukocyte antibodies in donor blood bind to circulatory  granulocytes in the recipient, and promote leukocyte sequestration in the pulmonary microvasculature. this then lead to  granulocyte mediated lung injury which presents as acute   respiratory distress syndrome or non cardiogenic pulm edema

CLINICAL FEATURES: Fever chills dyspnea hypoxemia, tachypnea tachycardia some times with  hypotension., within a few hrs of transfusion CXR shows diffuse pulmonary infiltrates, usually resolved in a week

TREATMENT:  Stop transfusion immediately,  consider mechanical ventilation if picture simulates ARDS, diuretics , morphine to reduce pulm edema, physiotherapy, antibiotics. and steroids
FUTURE TRANSFUSIONS: Either by washed rbcs, or autologous transfusion
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Canadian Consensus Conference proposed criteria for transfusion-related acute lung injury (TRALI).
Criteria for TRALI

•       Acute lung injury (ALI)
•       Acute onset, Hypoxemia

In research setting:      Ratio of PaO2/FiO2 300 or    SpO2 < 90% on room air

Non-research setting:   Ratio of PaO2/FiO2 300 or    SpO2 < 90% on room air

Other clinical evidence of hypoxia

• Bilateral infiltrates on frontal chest radiograph
• No evidence of left atrial hypertension (i.e., circulatory overload)
• No preexisting ALI before transfusion
• During or within 6 hours of transfusion; and
• No temporal relationship to an alternative risk factor for ALI

Criteria for possible TRALI

• ALI
• No preexisting ALI before transfusion
• During or within 6 hours of transfusion; and
• A clear temporal relationship to an alternative risk factor for ALI