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Transfusion Related Acute Lung Injury (TRALI) or Other Acute Lung Injury (ALI)?
Author(s) -
Michala S.,
De Lord C.,
MacRate E.,
Botfield C.,
Brown R.,
Win N.
Publication year - 2006
Publication title -
transfusion medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.471
H-Index - 59
eISSN - 1365-3148
pISSN - 0958-7578
DOI - 10.1111/j.1365-3148.2006.00694_15.x
Subject(s) - medicine , transfusion related acute lung injury , sepsis , respiratory distress , lung , diffuse alveolar damage , serology , mechanical ventilation , surgery , acute respiratory distress , pulmonary edema , antibody , immunology
Transfusion related acute lung injury (TRALI) is a form of acute lung injury (ALI) occurring within 6 h of transfusion. Patients presenting with TRALI are often indistinguishable from other causes of ALI. It is an increasingly recognized severe complication of transfusion. We present two cases where TRALI was strongly clinically suspected but only one case was serologically proven to be TRALI. Case 1: A 51 year old lady sustained a massive haemorrhage following an elective gynaecological procedure. 48 h later she returned to theatre and received 4 units of FFP and developed ALI. Case 2: A 28 year old had a postpartum haemorrhage following an emergency caesarian section. After receiving 3 units of RBC she developed respiratory failure. Both patients required ventilation but made a full recovery. Fluid overload, cardiogenic pulmonary oedema, sepsis and pulmonary thromboembolism were excluded and the cases were referred to the NBS for investigation of TRALI. In both cases, the expert panel consulted by the NBS was doubtful about the likelihood of TRALI since all 4 FFP units were collected from male donors and red cells are thought less likely to be implicated. However, all donors were contacted and investigated for WBC antibodies in their serum. Serology did not confirm the diagnosis in Case 1 but TRALI was confirmed in the second case where anti‐HNA1 antibodies were identified in one of the red cell donors and the patient typed as HNA‐1a positive. The diagnosis of TRALI is one of exclusion of other causes of ALI. Here we illustrate that despite the clinical similarities between the two patients, both strongly suspected of TRALI, only one was serologically confirmed to have TRALI. This highlights the difficulties in deciding which cases should be referred for further investigation. Although the referral process is complicated and requires a great deal of clinical input, TRALI needs to be considered as a cause of ALI following transfusion with all blood products, including RBCs. Finally, it is important to reach a diagnosis for both the patient concerned, as this may impact on their future management, and to exclude the implicated donors from further donations.