Canterbury DHB


Transfusion Related Acute Lung Injury (TRALI)

In This Section


Clinical Signs

Laboratory Diagnosis and Evaluation



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.

Differentiating TRALI from TACO


C Hillis, A Shih, N Heddle. (2016). Best practices in the differential diagnosis and reporting of acute transfusion reactions. International Journal of Clinical Transfusion Medicine. 4(1–14).


About this Canterbury DHB document (5118):

Document Owner:

Steve Gibbons (see Who's Who)

Last Reviewed:

June 2019

Next Review:

June 2022


Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 5118