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
