Transfusion-related acute lung injury - Revision history

Danbot: Strip excess bold

2026-03-22T09:28:58Z

Strip excess bold

← Older revision		Revision as of 09:28, 22 March 2026
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	===Pathophysiology===		===Pathophysiology===
	*Two-hit mechanism <ref name="four"></ref><ref>Sillman CC. The two-event model of transfusion-related acute lung injury. Crit Care Med. 2006;34:S124</ref><ref>Bux J, et al. The pathogenesis of transfusion-related acute lung injury (TRALI). Br J Haematol. 2007;136:788</ref>		*Two-hit mechanism <ref name="four"></ref><ref>Sillman CC. The two-event model of transfusion-related acute lung injury. Crit Care Med. 2006;34:S124</ref><ref>Bux J, et al. The pathogenesis of transfusion-related acute lung injury (TRALI). Br J Haematol. 2007;136:788</ref>
	**~~'''~~Neutrophil sequestration and priming in lung microvasculature~~'''~~		**Neutrophil sequestration and priming in lung microvasculature
	**~~'''~~Recipient neutrophil activation by factor in the blood product~~'''~~ (i.e. antibodies in blood component directed at recipient antigens, bioactive lipids, etc.)		**Recipient neutrophil activation by factor in the blood product (i.e. antibodies in blood component directed at recipient antigens, bioactive lipids, etc.)
	***Neutrophils release cytokines, reactive oxygen species, etc. that damage pulmonary capillary endothelium		***Neutrophils release cytokines, reactive oxygen species, etc. that damage pulmonary capillary endothelium
	****Leads to ~~'''~~inflammatory pulmonary edema~~'''~~		****Leads to inflammatory pulmonary edema

	===Risk factors===		===Risk factors===
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	==Clinical Features==		==Clinical Features==
	*~~'''~~Acute onset hypoxemic respiratory failure due to non-cardiogenic pulmonary edema occurring during or shortly after transfusion~~'''~~		*Acute onset hypoxemic respiratory failure due to non-cardiogenic pulmonary edema occurring during or shortly after transfusion
	**Majority of cases present within minutes of initiating transfusion <ref name="four"></ref>		**Majority of cases present within minutes of initiating transfusion <ref name="four"></ref>
	**Some present 1-2 hours post-transfusion and up to 6 hours after <ref name="one">Kleinman S, et al. Toward an understanding of transfusion-related acute lung injury: statement of a consensus panel. Transfusion. 2004;44:1774</ref><ref>Sillman CC, et al. Transfusion-related acute lung injury. Blood. 2005;105:2266</ref>		**Some present 1-2 hours post-transfusion and up to 6 hours after <ref name="one">Kleinman S, et al. Toward an understanding of transfusion-related acute lung injury: statement of a consensus panel. Transfusion. 2004;44:1774</ref><ref>Sillman CC, et al. Transfusion-related acute lung injury. Blood. 2005;105:2266</ref>
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	===Diagnosis===		===Diagnosis===
	*~~'''~~Clinical diagnosis~~'''~~		*Clinical diagnosis
	**Consider in any patient during/post-transfusion who develops hypoxemic respiratory insufficiency		**Consider in any patient during/post-transfusion who develops hypoxemic respiratory insufficiency
	**Diagnostic criteria (NHLBI working group and Canadian Consensus Conference on TRALI): <ref name="one"></ref><ref>Toy P, et al. Transfusion-related acute lung injury: definition and review. Crit Care Med. 2005;33:721</ref>		**Diagnostic criteria (NHLBI working group and Canadian Consensus Conference on TRALI): <ref name="one"></ref><ref>Toy P, et al. Transfusion-related acute lung injury: definition and review. Crit Care Med. 2005;33:721</ref>
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	==Management==		==Management==
	*~~'''~~STOP the transfusion~~'''~~ and report to the blood bank for transfusion reaction work-up		*STOP the transfusion and report to the blood bank for transfusion reaction work-up
	**Typically includes CBC, bilirubin, haptaglobin, direct Coombs test, BNP, HLA antigen typing		**Typically includes CBC, bilirubin, haptaglobin, direct Coombs test, BNP, HLA antigen typing
	*Supportive care (i.e. treat like ARDS)		*Supportive care (i.e. treat like ARDS)
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	**[[ECMO]] <ref>Worsley MH, et al. Non-cardiogenic pulmonary edema after transfusion with granulocyte antibody containing blood: treatment with extracorporeal membrane oxygenation. Br J Anaesth. 1991;67:116</ref>		**[[ECMO]] <ref>Worsley MH, et al. Non-cardiogenic pulmonary edema after transfusion with granulocyte antibody containing blood: treatment with extracorporeal membrane oxygenation. Br J Anaesth. 1991;67:116</ref>
	*Additional transfusions		*Additional transfusions
	**For those who recover, ~~'''~~no increased risk for recurrent episode from other donors~~'''~~		**For those who recover, no increased risk for recurrent episode from other donors
	***~~'''~~Transfusion of needed blood products from other donors should not be withheld~~'''~~		***Transfusion of needed blood products from other donors should not be withheld

	==Disposition==		==Disposition==

Rossdonaldson1: /* Background */

2024-04-24T18:43:35Z

Background

← Older revision		Revision as of 18:43, 24 April 2024
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	==Background==		==Background==
			[[File:Lung and diaphragm.jpg\|thumb\|Lobes of the lung with related anatomy.]]
	===Epidemiology===		===Epidemiology===
	*Leading cause of transfusion related mortality in the US – 5-8% <ref>Fatalities Reported to FDA Following Blood Collection and Transfusion: Annual Summary for Fiscal Year 2011. Available at www.fda/gov/biologicsbloodvaccines/safetyavailability/reportaproblem/transfusiondonationfatalities/ucm302847.htm</ref><ref name="sixteen">Looney MR, et al. Transfusion-related acute lung injury: a review. Chest. 2004;126:249</ref>		*Leading cause of transfusion related mortality in the US – 5-8% <ref>Fatalities Reported to FDA Following Blood Collection and Transfusion: Annual Summary for Fiscal Year 2011. Available at www.fda/gov/biologicsbloodvaccines/safetyavailability/reportaproblem/transfusiondonationfatalities/ucm302847.htm</ref><ref name="sixteen">Looney MR, et al. Transfusion-related acute lung injury: a review. Chest. 2004;126:249</ref>

Rossdonaldson1: /* Diagnosis */

2024-04-24T18:43:14Z

Diagnosis

← Older revision		Revision as of 18:43, 24 April 2024
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	*'''Clinical diagnosis'''		*'''Clinical diagnosis'''
	**Consider in any patient during/post-transfusion who develops hypoxemic respiratory insufficiency		**Consider in any patient during/post-transfusion who develops hypoxemic respiratory insufficiency
	*Diagnostic criteria (NHLBI working group and Canadian Consensus Conference on TRALI): <ref name="one"></ref><ref>Toy P, et al. Transfusion-related acute lung injury: definition and review. Crit Care Med. 2005;33:721</ref>		**Diagnostic criteria (NHLBI working group and Canadian Consensus Conference on TRALI): <ref name="one"></ref><ref>Toy P, et al. Transfusion-related acute lung injury: definition and review. Crit Care Med. 2005;33:721</ref>

	===[[TRALI]] and Possible TRALI===		===[[TRALI]] and Possible TRALI===

Rossdonaldson1: /* Diagnosis */

2024-04-24T18:42:59Z

Diagnosis

← Older revision		Revision as of 18:42, 24 April 2024
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	===Diagnosis===		===Diagnosis===
	*'''Clinical diagnosis''' ~~- consider~~ in any patient during/post-transfusion who develops hypoxemic respiratory insufficiency		*'''Clinical diagnosis'''
			**Consider in any patient during/post-transfusion who develops hypoxemic respiratory insufficiency
	*Diagnostic criteria (NHLBI working group and Canadian Consensus Conference on TRALI): <ref name="one"></ref><ref>Toy P, et al. Transfusion-related acute lung injury: definition and review. Crit Care Med. 2005;33:721</ref>		*Diagnostic criteria (NHLBI working group and Canadian Consensus Conference on TRALI): <ref name="one"></ref><ref>Toy P, et al. Transfusion-related acute lung injury: definition and review. Crit Care Med. 2005;33:721</ref>

Rossdonaldson1: /* Evaluation */

2024-04-24T18:42:42Z

Evaluation

← Older revision		Revision as of 18:42, 24 April 2024
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	==Evaluation==		==Evaluation==
	[[File:Transfusion-related acute lung injury chest X-ray.gif\|thumb\|Chest X-ray of transfusion-related acute lung injury (TRALI syndrome) compared to chest X-ray of the same subject afterwards.]]		[[File:Transfusion-related acute lung injury chest X-ray.gif\|thumb\|Chest X-ray of transfusion-related acute lung injury (TRALI syndrome) compared to chest X-ray of the same subject afterwards.]]
			===Workup===
			*ABG
			*[[CXR]]
			*Rule out other possible etiologies (i.e. CHF, TACO, anaphylaxis, sepsis, etc.)

			===Diagnosis===
	*'''Clinical diagnosis''' - consider in any patient during/post-transfusion who develops hypoxemic respiratory insufficiency		*'''Clinical diagnosis''' - consider in any patient during/post-transfusion who develops hypoxemic respiratory insufficiency

	*Diagnostic criteria (NHLBI working group and Canadian Consensus Conference on TRALI): <ref name="one"></ref><ref>Toy P, et al. Transfusion-related acute lung injury: definition and review. Crit Care Med. 2005;33:721</ref>		*Diagnostic criteria (NHLBI working group and Canadian Consensus Conference on TRALI): <ref name="one"></ref><ref>Toy P, et al. Transfusion-related acute lung injury: definition and review. Crit Care Med. 2005;33:721</ref>

	===[[TRALI]] and Possible TRALI===		===[[TRALI]] and Possible TRALI===

	ALI/[[ARDS]] risk factor- aspiration, toxic inhalation, pneumonia, pulmonary contusion, near drowning, shock, severe sepsis, multiple trauma, burn injury, acute pancreatitis, cardiopulmonary bypass, drug overdose		ALI/[[ARDS]] risk factor- aspiration, toxic inhalation, pneumonia, pulmonary contusion, near drowning, shock, severe sepsis, multiple trauma, burn injury, acute pancreatitis, cardiopulmonary bypass, drug overdose
	**Diagnosis of "possible TRALI" (aka "transfused ARDS") made when temporal relationship to an alternative cause for ARDS exists		**Diagnosis of "possible TRALI" (aka "transfused ARDS") made when temporal relationship to an alternative cause for ARDS exists

	~~===Workup===~~
	*ABG
	*[[CXR]]
	*Rule out other possible etiologies (i.e. CHF, TACO, anaphylaxis, sepsis, etc.)

	{{TRALI vs TACO}}		{{TRALI vs TACO}}

Rossdonaldson1: /* Evaluation */

2024-04-24T18:41:55Z

Evaluation

← Older revision		Revision as of 18:41, 24 April 2024
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	==Evaluation==		==Evaluation==
			[[File:Transfusion-related acute lung injury chest X-ray.gif\|thumb\|Chest X-ray of transfusion-related acute lung injury (TRALI syndrome) compared to chest X-ray of the same subject afterwards.]]
	*'''Clinical diagnosis''' - consider in any patient during/post-transfusion who develops hypoxemic respiratory insufficiency		*'''Clinical diagnosis''' - consider in any patient during/post-transfusion who develops hypoxemic respiratory insufficiency

Rossdonaldson1: /* Clinical Features */

2023-10-25T17:38:41Z

Clinical Features

← Older revision		Revision as of 17:38, 25 October 2023
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	**New pulmonary infiltrates		**New pulmonary infiltrates
	**Pink frothy secretions via ETT		**Pink frothy secretions via ETT
	**[[Fever]] (as opposed to TACO where fever is uncommon)		**[[Fever]] (as opposed to [[TACO]], where fever is uncommon)
	**[[Hypotension]]		**[[Hypotension]]
	**Cyanosis		**Cyanosis

Cmb23: /* Clinical Features */

2023-10-22T02:00:58Z

Clinical Features

← Older revision		Revision as of 02:00, 22 October 2023
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	**New pulmonary infiltrates		**New pulmonary infiltrates
	**Pink frothy secretions via ETT		**Pink frothy secretions via ETT
	**[[Fever]]		**[[Fever]] (as opposed to TACO where fever is uncommon)
	**[[Hypotension]]		**[[Hypotension]]
	**Cyanosis		**Cyanosis

Elcatracho: /* Recipient factorsVlaar AP, et al. Risk factors and outcome of transfusion-related acute lung injury in the critically ill: a nested case-control study. Crit Care Med. 2007;176:886Gajic O, et al. Transfusion-related acute lung injury in the criticall...

2021-02-11T21:50:23Z

/* Recipient factorsVlaar AP, et al. Risk factors and outcome of transfusion-related acute lung injury in the critically ill: a nested case-control study. Crit Care Med. 2007;176:886Gajic O, et al. Transfusion-related acute lung injury in the criticall...

← Older revision		Revision as of 21:50, 11 February 2021
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	*Critical illness		*Critical illness
	*[[Sepsis]]		*[[Sepsis]]
	*Shock		*[[Shock]]

	====Blood component factors<ref name="fifteen"></ref>====		====Blood component factors<ref name="fifteen"></ref>====

Elcatracho: /* Recipient factorsVlaar AP, et al. Risk factors and outcome of transfusion-related acute lung injury in the critically ill: a nested case-control study. Crit Care Med. 2007;176:886Gajic O, et al. Transfusion-related acute lung injury in the criticall...

2021-02-11T21:50:04Z

← Older revision		Revision as of 21:50, 11 February 2021
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	*Liver disease		*Liver disease
	*Hematologic malignancy		*Hematologic malignancy
	*Alcohol abuse		*[[Ethanol toxicity\|Alcohol abuse]]
	*High peak airway pressures on mechanical ventilation		*High peak airway pressures on mechanical ventilation
	*Current smoking		*Current smoking
	*Positive fluid balance		*Positive fluid balance
	*Massive transfusion		*[[Massive transfusion]]
	*Critical illness		*Critical illness
	*Sepsis		*[[Sepsis]]
	*Shock		*Shock