Transfusion-related acute lung injury: A dangerous and underdiagnosed noncardiogenic pulmonary edema

Abstract

Transfusion-related acute lung injury (TRALI) is one of the leading causes of death associated with transfusion of blood and blood components. The understanding of the etiology and pathophysiology of this syndrome has much improved during the last decades, nevertheless numerous issues are still unresolved and symptomatic treatment remains the cornerstone of medical management. Consequently more attention is directed at primary as well as secondary prevention. The awareness of the problem within the medical society is still unsatisfactory which results in a high number of unrecognized cases or of inaccurate diagnoses one of which is cardiogenic pulmonary edema. The aim of this review is to make the TRALI syndrome morefamiliar to clinicians and to emphasize how signifi cant proper medical management is both for the patients presenting TRALI symptoms as well as for future recipients of blood components. (Cardiol J 2013; 20, 4: 337-344)

Case study of transfusion related acute lung injury in intensive care unit

“…It has been a long time since then and procedures have become safer for patients, thus reducing the danger of transmission of diseases and complications. [2] Only in 2004 TRALI was officially recognised during a conference held at Toronto by the National Institute of Health as a severe complication of blood transfusion and was clinically separated from Acute Lung Injury (ALI) which until then was not connected to it. The clinical features of TRALI are dyspnea, hypoxaemia and infiltrations of lungs in both sides that appear on chest X-ray.…”

“…It is a rare complication following transfusion of blood and blood products and in particular whole blood, Packed Red Blood Cells (PRBC), Platelets (PLT) and Fresh Frozen Plasma (FFP). [1,2] It is a non-cardiogenic pulmonary oedema that often occurs within the first six hours following blood components transfusion. Its frequency, according to international literature, is estimated to occur in 1:5000 transfusions with fatality 5%-10% of the total number of transfusions.…”

“…Its frequency, according to international literature, is estimated to occur in 1:5000 transfusions with fatality 5%-10% of the total number of transfusions. [2][3][4][5][6] The etiology of the syndrome remains not fully understood; due to that health professionals should report the events ending to TRALI, as well as their way of treatment in order to acquire some type of "experience". In the future, this will improve the possible approaches in order to save the patient's life.…”

Transfusion-Related Acute Lung Injury in Multiple Trauma Patient: Successful Use of Extracorporeal Membrane Oxygenation

“…4 [2,3]. It should be emphasized that antibody detection is not indispensable for TRALI diagnosis which is primarily based on the clinical picture [4]. The incidence of TRALI: 0.08-15 % patients after transfusion.…”

New insights in prevention and treatment of sepsis-induced acute kidney injury

“…[28] This apparent "transfusion-related AKI" could be coined by the acronym "TRAKI" in analogy to the recognized "TRALI" which stands for "transfusion related acute lung injury". [29] Regarding prevention of SAKI, a hematocrit level of 25% may be a more realistic target. [28] Interestingly, the introduction of citrate as an anticoagulant during CRRT has resulted in significantly lower transfusion needs.…”