What is transfusion-related acute lung injury (TRALI)?

By William Aird

Form of acute lung injury caused by donor leukocyte antibodies (occasionally in recipient) and other leukocyte activating agents in plasma-containing components including whole blood, RBCs, platelets, cryoprecipitate, and fresh frozen plasma. Symptoms arise within 6 hours of transfusion and typically resolve after 48-96 hours. Treatment is supportive.

The Canadian Consensus Criteria defines TRALI as acute pulmonary edema after transfusion in the absence of circulatory overload or alternate acute respiratory distress syndrome (ARDS) risk factors:

According to the AABB, TRALI is defined as:

  • No evidence of acute lung injury (ALI) prior to transfusion, and
  • ALI onset during or within 6 hours of cessation of transfusion, and
  • Radiographic evidence of bilateral infiltrates, and
  • No evidence of left atrial hypertension (i.e., circulatory overload), and
  • Hypoxemia defined by any of these methods:
    • PaO2/FiO2 less than or equal to 300 mmHg
    • Oxygen saturation less than 90% on room air
    • Other clinical evidence
From Hematology Am Soc Hematol Educ Program. 2018;2018:585-594.