Open AccessTransfusion‐Related Acute Lung Injury
Author(s) -
Kokkini Garyfallia
Publication year - 2002
Publication title -
transfusion alternatives in transfusion medicine
Language(s) - English
Resource type - Journals
eISSN - 1778-428X
pISSN - 1295-9022
DOI - 10.1111/j.1778-428x.2002.tb00062.x
Subject(s) - medicine , transfusion related acute lung injury , pulmonary edema , intensive care medicine , limiting , granulocyte , respiratory distress , acute respiratory distress , blood product , lung , pathogenesis , blood transfusion , diffuse alveolar damage , immunology , anesthesia , surgery , mechanical engineering , engineering
SUMMARY Transfusion‐related acute lung injury (TRALI) is the adult respiratory distress syndrome arising from transfusion of a plasma‐containing blood product. It occurs within 1–6 hours of transfusion and is the third leading cause of transfusion‐related mortality in developed countries. TRALI patients present with dyspnea, hypotension, fever, and bilateral noncardiogenic pulmonary edema. Effective treatment includes stopping the transfusion and providing supportive care, whose intensity will depend on the clinical picture. Approximately 80% of TRALI patients recover within 96 hours. TRALI may result from multiple mechanisms. In most cases, pathogenesis appears to reflect the presence of granulocyte or HLA antibodies in donor blood. These react with and fix complement to antigens in the recipient, which leads to granulocyte aggregation, activation, and severe capillary leakage. Preventive measures should focus on limiting exposure to donors most likely to precipitate TRALI. Implicated donors are multiparous females and donors with previous multiple exposure to allogeneic transfusions. Clear recommendations and guidelines for preventing TRALI are needed.