Transfusion-Related Acute Lung Injured (TRALI): Current Concepts

Abstract

Transfusion-related acute lung injury (TRALI) is a life-threatening intervention that develops within 6 hours of transfusion of one or more units of blood, and is an important cause of morbidity and mortality resulting from transfusion. It is necessary to dismiss other causes of acute lung injury (ALI), like sepsis, acute cardiogenic edema, acute respiratory distress syndrome (ARDS) or bacterial infection. There are two mechanisms that lead to the development of this syndrome: immune-mediated and no immune- mediated TRALI. A common theme among the experimental TRALI models is the central importance of neutrophils in mediating the early immune response, and lung vascular injury. Central clinical symptoms are dyspnea, tachypnea, tachycardia, cyanosis and pulmonary secretions, altogether with other hemodynamic alterations, such as hypotension and fever. Complementary to these clinical findings, long-term validated animal models for TRALI should allow the determination of the cellular targets for TRALI-inducing alloantibodies as well as delineation of the underlying pathogenic molecular mechanisms, and key molecular mediators of the pathology. Diagnostic criteria have been established and preventive measures have been implemented. These actions have contributed to the reduction in the overallnumber of fatalities. However, TRALI still remains a clinical problem. Any complication suspected of TRALI should immediately be reported.

Immunothrombosis in Acute Respiratory Distress Syndrome: Cross Talks between Inflammation and Coagulation

“…Gando and Otomo [39] have recently described the role of immunothrombosis in acute coagulopathy of trauma shock; they concluded that in trauma patients the mechanism of immunothrombosis and hemostasis is dysregulated and the endothelial injury leads to fibrinogenolysis and subsequent diffuse oozing. Moreover, immunothrombosis and the particular role of extracellular histones have been extensively studied in transfusion-related acute lung injury (TRALI) models [40,41] . However, it seems that, irrespectively of the different pathogenic factors causing ARDS, the inflammatory process is the common pathway triggering the mechanism of microvascular thrombosis.…”

“…Consequently, neutrophils were activated, with subsequent release of NETs, especially in pulmonary capillaries, resulting in severe lung injury [2] . NETs have also been implicated in the pathophysiology of TRALI, which is one of the most severe complications of transfusion, defined as lung injury developing within 6 h of transfusion of 1 or more units [41] . Animal and human studies concerning TRALI have shown that NETs are found in abundance in the lungs and circulation [40] .…”

Massive pulmonary hemorrhage before living donor liver transplantation in infants

“…In addition, she had no other suspicious gastrointestinal bleeding symptoms such as hematemesis or melena, so the possibility of massive aspiration of bloody vomiting was easily denied. On the other hand, we could not completely distinguish the diagnosis of TRALI, which develops pulmonary edema within six h of transfusion of one or more units of blood , although she had not received a blood transfusion within six h prior to onset of pulmonary hemorrhage. Her hemoglobin level decreased to 3.9 g/dL, the platelet count was 1.5 × 10 4 /μL, the PT was 26%, the INR was 2.59, and the T.Bil elevated to 52.4 mg/dL.…”

Transfusion reaction and hemovigilance: An imperative discussion in Brazilian hemotherapy services

“…In most cases, such complication occurs in the passive transfer of alloantibodies originating from donors who have been previously sensitized by leukocyte antigens [8,34]. As an attempt to reduce TRALI risk, ordinance no.…”