Transfusion-Related Acute Lung Injury (TRALI)

The clinical syndrome of transfusion-related acute lung injury (TRALI) is characterised by the acute onset of respiratory distress during or within six hours of transfusion. An important syndrome in the differential diagnosis of TRALI is transfusion-associated circulatory overload (TACO), which similarly results in hypoxaemic respiratory insufficiency and manifests with pulmonary oedema. The pathogenesis of TRALI is complex and incompletely understood. Generally, the pathogenesis can be viewed as a two-hit model, where the first hit represents the underlying clinical condition of the transfused recipient and the second hit is conveyed by components in the transfused blood product. If TRALI is suspected, the transfusion should be stopped immediately. Patient management is supportive as there are no specific therapeutic interventions. It is recommended that all pulmonary complications after blood transfusion should be reported to the transfusion service.