Case Of the Week (COW) 08 May 2016
TRALI - Transfusion Related Acute Lung Injury
Discussion:
Transfusion related acute lung injury (TRALI) is a serious blood transfusion complication characterized by the acute onset of non-cardiogenic pulmonary edema following transfusion of blood products. The typical presentation of TRALI is the sudden development of dyspnea, severe hypoxemia (O2 saturation <90% in room air), hypotension, and fever that develop within 6 hours after transfusion and usually resolve with supportive care within 48 to 96 hours. Radiographic finding shows diffuse, fluffy infiltrates consistent with pulmonary edema, which may be patchy in the first few hours, with progression of the alveolar and interstitial infiltrates such that the entire lung is obscured. Resolution often occurs rapidly, even when initial hypoxemia is severe. Most patients can be extubated within 48 hours, and chest radiographs typically return to normal in 4 days, although hypoxemia and pulmonary infiltrates persist up to 7 days in a minority of patients. The first step in the treatment of TRALI is to make the correct diagnosis. Treating TRALI like cardiogenic pulmonary edema or volume overload may lead to adverse outcomes. Treatment is supportive, with a prognosis substantially better than most causes of clinical acute lung injury.
TRALI - Transfusion Related Acute Lung Injury
Discussion:
Transfusion related acute lung injury (TRALI) is a serious blood transfusion complication characterized by the acute onset of non-cardiogenic pulmonary edema following transfusion of blood products. The typical presentation of TRALI is the sudden development of dyspnea, severe hypoxemia (O2 saturation <90% in room air), hypotension, and fever that develop within 6 hours after transfusion and usually resolve with supportive care within 48 to 96 hours. Radiographic finding shows diffuse, fluffy infiltrates consistent with pulmonary edema, which may be patchy in the first few hours, with progression of the alveolar and interstitial infiltrates such that the entire lung is obscured. Resolution often occurs rapidly, even when initial hypoxemia is severe. Most patients can be extubated within 48 hours, and chest radiographs typically return to normal in 4 days, although hypoxemia and pulmonary infiltrates persist up to 7 days in a minority of patients. The first step in the treatment of TRALI is to make the correct diagnosis. Treating TRALI like cardiogenic pulmonary edema or volume overload may lead to adverse outcomes. Treatment is supportive, with a prognosis substantially better than most causes of clinical acute lung injury.