Transfusion-related acute lung injury

Background

• Due to granulocyte recruitment and degranulation within the lung
• More common with FFP and platelet transfusions (extremely rare with pRBC transfusion alone)
  • pRBCs do contain residual plasma and can have TRALI

Clinical Features

• ARDS-like symptoms

Differential Diagnosis

Transfusion Reaction Types

• Acute
  • Intravascular hemolytic tranfusion reaction
  • Febrile nonhemolytic tranfusion reaction
  • Allergic tranfusion reaction
  • Transfusion-associated circulatory overload (TACO)
  • Transfusion-related acute lung injury (TRALI)
  • Transfusion-associated graft-versus-host disease
  • Fluid overload
  • Sepsis
• Delayed
  • Extravascular hemolytic tranfusion reaction
  • Graft-vs-host disease
  • Transfusion infections

Diagnosis

• Time Frame: abrupt to within 6 hours of transfusion initiation

Management

• • Strop transfusion
  • Treat like ARDS
  • Avoid diuresis

Disposition

• Bilateral pulmonary infiltrates due to noncardiogenic pulmonary edema within 6h of transfusion

See Also

• Transfusion reaction