TRALI ( Transfusion related acute lung injury )
1. Definition - it is acute lung injury which occurs within 6 hours of completion of transfusion of blood components.
Pathogenesis - two hit hypothesis.
First hit is the priming event like endothelial activation which leads to increased sequestration and
sensitisation of neutrophils in the micro vasculature of lung. Second hit can be the antibodies in
the transfused blood product that recognise antigens expressed on neutrophils. Most common
antibodies can be those that bind MHC antigens.
2. TRALI can occur with all plasma containing products but more common with transfusion of FFP and platelets.
3. Clinically - dyspnea, tachypnea, fever, hypotension.
4. Chest X Ray - bilateral pulmonary infiltrates or white out lung. That is why most important differential diagnosis is ARDS.
Pathogenesis - two hit hypothesis.
First hit is the priming event like endothelial activation which leads to increased sequestration and
sensitisation of neutrophils in the micro vasculature of lung. Second hit can be the antibodies in
the transfused blood product that recognise antigens expressed on neutrophils. Most common
antibodies can be those that bind MHC antigens.
2. TRALI can occur with all plasma containing products but more common with transfusion of FFP and platelets.
3. Clinically - dyspnea, tachypnea, fever, hypotension.
4. Chest X Ray - bilateral pulmonary infiltrates or white out lung. That is why most important differential diagnosis is ARDS.
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