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CARDIOVASCULAR ANESTHESIA

Transfusion-Related Acute Lung Injury

Pearl Toy, MD^*, and Ognjen Gajic, MD

*Department of Laboratory Medicine, University of California San Francisco, San Francisco, California; and Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota

Address correspondence and reprint requests to Pearl Toy, MD, Box 0100, University of California San Francisco, San Francisco, CA 94143-0100. Address e-mail to pearl.toy{at}clinlab.ucsfmedctr.org

Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related mortality. It is characterized by injury to the alveolar-capillary membrane precipitated by transfusion factors, antibodies, and/or inflammatory mediators, in a susceptible host. In the absence of a specific test, TRALI is defined clinically as a syndrome of acute lung injury that develops during or within 6 h of transfusion. The absence of left atrial hypertension and large protein content of edema fluid may help differentiate TRALI from hydrostatic pulmonary edema. The treatment is supportive. The blood bank needs to be notified promptly so that an appropriate workup and prevention are initiated in a timely manner.

IMPLICATIONS: Transfusion may rarely cause acute lung injury. Diagnosis is difficult because there is no single test for the condition. Diagnosis and management are described. Earlier recognition may lead to earlier diagnosis, treatment, and prevention.

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