Transfusion-related acute lung injury

Background

• Due to granulocyte recruitment and degranulation within the lung
• More common with FFP and platelet transfusions (extremely rare with pRBC transfusion alone)
  • pRBCs do contain residual plasma and can have TRALI

Clinical Features

• Time Frame: abrupt to within 6 hours of transfusion initiation
• ARDS-like symptoms

Differential Diagnosis

Transfusion Reaction Types

• Acute
  • Intravascular hemolytic tranfusion reaction
  • Febrile nonhemolytic tranfusion reaction
  • Allergic tranfusion reaction
  • Transfusion-associated circulatory overload (TACO)
  • Transfusion-related acute lung injury (TRALI)
  • Transfusion-associated graft-versus-host disease
  • Fluid overload
  • Sepsis
• Delayed
  • Extravascular hemolytic tranfusion reaction
  • Graft-vs-host disease
  • Transfusion infections

Acute allergic reaction

• Allergic reaction/urticaria
• Anaphylaxis
• Angioedema
• Anxiety attack
• Asthma exacerbation
• Carcinoid syndrome
• Cold urticaria
• Contrast induced allergic reaction
• Scombroid
• Shock
• Transfusion reaction

Evaluation

TRALI vs TACO

	TRALI	TACO
Onset	Acute, within 6hrs	Often more gradual
BP	Low	High
Temp	Febrile	Normal
JVD/pedal edema	Unlikely	Likely
CVP/PAWP	Normal	Elevated
BNP	Normal	Elevated
Resp	Dyspneic	Dyspneic
CXR	B/l infiltrates	B/l infiltrates

Management

• Strop transfusion
• Treat like ARDS
• Avoid diuresis

Disposition

• Bilateral pulmonary infiltrates due to noncardiogenic pulmonary edema within 6h of transfusion

See Also

• Transfusion reaction