Transfusion-Related Acute Lung Injury With Fatal Outcome

Abstract

Transfusion-related acute lung injury (TRALI) is a life-threatening complication of blood transfusion and has emerged as a leading cause of transfusion-associated morbidity and mortality. Prospective data of patients in the intensive care units have documented a significantly higher incidence of TRALI than previously reported. TRALI is likely to be under diagnosed due to a lack of awareness and understanding of this clinical entity, and because of the clinical presentation mirroring acute respiratory distress syndrome with its various potential aetiologies. We present a case of fatal TRALI in a 61-year-old man, who exhibited acute onset of respiratory distress postoperatively in association with transfusion of fresh frozen plasma (FFP) containing human leukocyte antigen (HLA) antibodies reactive with patient HLA. The patient had just been pneumonectomied. Risk factors of the blood component as well as patient specific risk factors determining the risk of TRALI are discussed. There is a need to increase the awareness and reporting of this diagnosis, in part to promptly institute the appropriate treatment and in part to identify and defer donors implicated in TRALI. Furthermore, awareness of this type of complication to transfusion of blood products could increase rational use of blood products, including minimising the use of FFP as volume therapy.




doi: http://dx.doi.org/10.4021/jh38e