Transfusion-related acute lung injury (TRALI)

Current clinical and pathophysiologic considerations

Kelly Swanson, Denis M Dwyre, Jessica Krochmal, Thomas J. Raife

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Transfusion-related acute lung injury (TRALI) is a rare transfusion reaction presenting as respiratory distress during or after transfusion of blood products. TRALI varies in severity, and mortality is not uncommon. TRALI reactions have equal gender distributions and can occur in all age groups. All blood products, except albumin, have been implicated in TRALI reactions. TRALI presents as acute respiratory compromise occurring in temporal proximity to a transfusion of a blood product. Other causes of acute lung injury should be excluded in order to definitively diagnose TRALI. Clinically and pathologically, TRALI mimics acute respiratory distress syndrome (ARDS), with neutrophil-derived inflammatory chemokines and cytokines believed to be involved in the pathogenesis of both entities. Anti-HLA and anti-neutrophil antibodies have been implicated in some cases of TRALI. Treatment for TRALI is supportive; prevention is important. It is suspected that TRALI is both underdiagnosed and underreported. One of the difficulties in the evaluation of potential TRALI reactions is, until recently, the lack of diagnostic criteria. A group of transfusion medicine experts, the American-European Consensus Conference (AECC), recently met and developed diagnostic criteria of TRALI, as well as recommendations for management of donors to prevent future TRALI reactions. In light of the AECC consensus recommendations, we report an incident of TRALI in an oncology patient as an example of the potential severity of the lung disease and the clinical and laboratory evaluation of the patient. We also review the literature on this important complication of blood transfusion that internists may encounter.

Original languageEnglish (US)
Pages (from-to)177-185
Number of pages9
JournalLung
Volume184
Issue number3
DOIs
StatePublished - Jun 2006
Externally publishedYes

Fingerprint

Acute Lung Injury
Blood Transfusion
Neutrophils
Transfusion Medicine
Adult Respiratory Distress Syndrome
Chemokines
Lung Diseases

Keywords

  • Leukocyte
  • Pulmonary injury
  • TRALI
  • Transfusion reaction

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Physiology

Cite this

Transfusion-related acute lung injury (TRALI) : Current clinical and pathophysiologic considerations. / Swanson, Kelly; Dwyre, Denis M; Krochmal, Jessica; Raife, Thomas J.

In: Lung, Vol. 184, No. 3, 06.2006, p. 177-185.

Research output: Contribution to journalArticle

Swanson, Kelly ; Dwyre, Denis M ; Krochmal, Jessica ; Raife, Thomas J. / Transfusion-related acute lung injury (TRALI) : Current clinical and pathophysiologic considerations. In: Lung. 2006 ; Vol. 184, No. 3. pp. 177-185.
@article{29cdbe475caa4e88979aa66bbf038510,
title = "Transfusion-related acute lung injury (TRALI): Current clinical and pathophysiologic considerations",
abstract = "Transfusion-related acute lung injury (TRALI) is a rare transfusion reaction presenting as respiratory distress during or after transfusion of blood products. TRALI varies in severity, and mortality is not uncommon. TRALI reactions have equal gender distributions and can occur in all age groups. All blood products, except albumin, have been implicated in TRALI reactions. TRALI presents as acute respiratory compromise occurring in temporal proximity to a transfusion of a blood product. Other causes of acute lung injury should be excluded in order to definitively diagnose TRALI. Clinically and pathologically, TRALI mimics acute respiratory distress syndrome (ARDS), with neutrophil-derived inflammatory chemokines and cytokines believed to be involved in the pathogenesis of both entities. Anti-HLA and anti-neutrophil antibodies have been implicated in some cases of TRALI. Treatment for TRALI is supportive; prevention is important. It is suspected that TRALI is both underdiagnosed and underreported. One of the difficulties in the evaluation of potential TRALI reactions is, until recently, the lack of diagnostic criteria. A group of transfusion medicine experts, the American-European Consensus Conference (AECC), recently met and developed diagnostic criteria of TRALI, as well as recommendations for management of donors to prevent future TRALI reactions. In light of the AECC consensus recommendations, we report an incident of TRALI in an oncology patient as an example of the potential severity of the lung disease and the clinical and laboratory evaluation of the patient. We also review the literature on this important complication of blood transfusion that internists may encounter.",
keywords = "Leukocyte, Pulmonary injury, TRALI, Transfusion reaction",
author = "Kelly Swanson and Dwyre, {Denis M} and Jessica Krochmal and Raife, {Thomas J.}",
year = "2006",
month = "6",
doi = "10.1007/s00408-005-2578-8",
language = "English (US)",
volume = "184",
pages = "177--185",
journal = "Lung",
issn = "0341-2040",
publisher = "Springer New York",
number = "3",

}

TY - JOUR

T1 - Transfusion-related acute lung injury (TRALI)

T2 - Current clinical and pathophysiologic considerations

AU - Swanson, Kelly

AU - Dwyre, Denis M

AU - Krochmal, Jessica

AU - Raife, Thomas J.

PY - 2006/6

Y1 - 2006/6

N2 - Transfusion-related acute lung injury (TRALI) is a rare transfusion reaction presenting as respiratory distress during or after transfusion of blood products. TRALI varies in severity, and mortality is not uncommon. TRALI reactions have equal gender distributions and can occur in all age groups. All blood products, except albumin, have been implicated in TRALI reactions. TRALI presents as acute respiratory compromise occurring in temporal proximity to a transfusion of a blood product. Other causes of acute lung injury should be excluded in order to definitively diagnose TRALI. Clinically and pathologically, TRALI mimics acute respiratory distress syndrome (ARDS), with neutrophil-derived inflammatory chemokines and cytokines believed to be involved in the pathogenesis of both entities. Anti-HLA and anti-neutrophil antibodies have been implicated in some cases of TRALI. Treatment for TRALI is supportive; prevention is important. It is suspected that TRALI is both underdiagnosed and underreported. One of the difficulties in the evaluation of potential TRALI reactions is, until recently, the lack of diagnostic criteria. A group of transfusion medicine experts, the American-European Consensus Conference (AECC), recently met and developed diagnostic criteria of TRALI, as well as recommendations for management of donors to prevent future TRALI reactions. In light of the AECC consensus recommendations, we report an incident of TRALI in an oncology patient as an example of the potential severity of the lung disease and the clinical and laboratory evaluation of the patient. We also review the literature on this important complication of blood transfusion that internists may encounter.

AB - Transfusion-related acute lung injury (TRALI) is a rare transfusion reaction presenting as respiratory distress during or after transfusion of blood products. TRALI varies in severity, and mortality is not uncommon. TRALI reactions have equal gender distributions and can occur in all age groups. All blood products, except albumin, have been implicated in TRALI reactions. TRALI presents as acute respiratory compromise occurring in temporal proximity to a transfusion of a blood product. Other causes of acute lung injury should be excluded in order to definitively diagnose TRALI. Clinically and pathologically, TRALI mimics acute respiratory distress syndrome (ARDS), with neutrophil-derived inflammatory chemokines and cytokines believed to be involved in the pathogenesis of both entities. Anti-HLA and anti-neutrophil antibodies have been implicated in some cases of TRALI. Treatment for TRALI is supportive; prevention is important. It is suspected that TRALI is both underdiagnosed and underreported. One of the difficulties in the evaluation of potential TRALI reactions is, until recently, the lack of diagnostic criteria. A group of transfusion medicine experts, the American-European Consensus Conference (AECC), recently met and developed diagnostic criteria of TRALI, as well as recommendations for management of donors to prevent future TRALI reactions. In light of the AECC consensus recommendations, we report an incident of TRALI in an oncology patient as an example of the potential severity of the lung disease and the clinical and laboratory evaluation of the patient. We also review the literature on this important complication of blood transfusion that internists may encounter.

KW - Leukocyte

KW - Pulmonary injury

KW - TRALI

KW - Transfusion reaction

UR - http://www.scopus.com/inward/record.url?scp=33747150062&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33747150062&partnerID=8YFLogxK

U2 - 10.1007/s00408-005-2578-8

DO - 10.1007/s00408-005-2578-8

M3 - Article

VL - 184

SP - 177

EP - 185

JO - Lung

JF - Lung

SN - 0341-2040

IS - 3

ER -