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Transfusion-related acute lung injury (TRALI)

Authors
Steven Kleinman, MD
Daryl J Kor, MD
Section Editors
Arthur J Silvergleid, MD
Scott Manaker, MD, PhD
Deputy Editor
Jennifer S Tirnauer, MD

INTRODUCTION

Transfusion-related acute lung injury (TRALI) is a rare but potentially fatal complication of blood product transfusion. TRALI has been defined by both a National Heart, Lung, and Blood Institute (NHLBI) working group as well as a Canadian Consensus Conference, as new acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) occurring during or within six hours after blood product administration (table 1) [1,2]. When a clear temporal relationship to an alternative risk factor for ALI/ARDS coexists, a formal diagnosis of TRALI cannot be made. In these circumstances, the diagnostic terminology to be used is either "possible TRALI" or "transfused ARDS."

Prior to the institution of TRALI risk mitigation strategies, plasma components and apheresis platelet concentrates conferred the highest risk of TRALI per component. Currently, due to transfusion of a much larger number of red cell units compared with plasma and platelets, the largest number of TRALI-related deaths in the United States and other developed countries occur with red blood cell transfusion [3]. (See 'Prevention' below.)

The epidemiology, pathogenesis, risk factors, clinical features, management, and prevention strategies for TRALI are presented here. General issues related to blood transfusion, other reactions to transfusion therapies, and general issues related to acute lung injury are discussed separately.

(See "Immunologic blood transfusion reactions".)

(See "Transfusion-associated circulatory overload (TACO)".)

                          

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Literature review current through: Nov 2016. | This topic last updated: Thu Jul 09 00:00:00 GMT 2015.
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