TRALI--definition, mechanisms, incidence and clinical relevance.
Transfusion-related acute lung injury (TRALI) is defined as new acute lung injury (ALI) that occurs during or within six hours of transfusion, not explained by another ALl risk factor. Transfusion of part of one unit of any blood product can cause TRALI. The mechanism may include factors in unit(s) of blood, such as antibody and biologic response modifiers. In addition, yet to be described factors in a patient's illness may predispose to the condition. The current incidence is estimated to be 1 in 5000 units. Patients present with acute dyspnea, or froth in the endotracheal tube in intubated patients. Hypertension, hypotension, acute leukopenia have been described. Management is similar to that for ALI and is predominantly supportive. When TRALI is suspected, Blood banks should be notified to quarantine other components from the same donation. No special blood product is required for subsequent transfusion of a patient who has developed TRALI.
Toy
Pearl
P
University of California San Francisco, San Francisco, CA 94143-0100, USA. pearl.toy@clinlab.ucsfmedctr.org
Lowell
Clifford
C
D001782:Blood Donors; D020022:Genetic Predisposition to Disease; D006801:Humans; D015994:Incidence; D017410:Practice Guidelines as Topic; D011654:Pulmonary Edema / Q000453:epidemiology / Q000209:etiology*; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology*; D018570:Risk Assessment; D012307:Risk Factors; D065227:Transfusion Reaction