Transfusion Related Acute Lung Injury (TRALI)

This is sometimes referred to as non-cardiogenic pulmonary oedema, or pulmonary type transfusion reaction. Most commonly, it is due to donor white cell (granulocyte) antibodies reacting with patient leucocytes. Less commonly, the leucocyte antibodies are present in the patient and react with the granulocytes in the transfused unit, usually only with granulocyte transfusions. With both mechanisms, large quantities of leucocyte aggregates are formed, and become trapped in the pulmonary capillaries with subsequent leucocyte and complement activation and immune response. It is more commonly associated with blood products with high plasma content (platelets and FFP).

TRALI is more common in unwell/hospitalised patients. Its incidence has reduced with the use of FFP from male donors only.

Clinical Signs

Laboratory Diagnosis and Evaluation

Standard transfusion reaction investigations are negative. A common differential diagnosis is Transfusion-associated circulatory overload (TACO). The table below might help differentiate between the two respiratory-type reactions.

Reference

Management


About this Canterbury DHB document (5118):
Document Owner:	Steve Gibbons (see Who's Who)
Last Reviewed:	June 2019
Next Review:	June 2022
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Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
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