TRALI

Question 1

Definition

Answer 1

Sudden onset noncardiogenic pulmonary oedema occurring within a few hrs after transfusion- m/c with plasma

Question 2

Pathogenesis

Answer 2

Largely unclear

Hypothesis:
Activation of recipient’s Leucocytes due to antibodies in donor plasma or,
reactive lipids in aged cellular blood contributing factors.

• Activated leukocytes-sequestered in the lungs —>cause damage to
  the capillary-alveolar membrane leading to congestion, hypoxia, pulmonary oedema, hypovolemia, hypotension, and fever

Question 3

Lab findings

Answer 3

hemoconcentration,
hypoalbuminemia neutropenia or neutrophilia

Question 4

Treatment

Answer 4

Early diagnosis is important to prevent administration of
diuretics that may be detrimental in TRALI.
- Treatment includes oxygen administration
-mechanical ventilation (required in approximately 68% of cases).
- Corticosteroids have been advocated by some authors, although role has never been evaluated by RCTs

Question 5

Prognosis

Answer 5

clinical course often benign
Improvement starts after 24-48hrs
Nil sequelae observed if pt——-survives
Accounts for 5% transfusion related mortality

Question 6

Prevention

Answer 6

-Most imp measure
Avoid unnecessary transfusions
Use PRBC where possible minimising use of plasma
Avoid use of plasma from multiparous women who are autoimmunized against leukocyte antigens during pregnancy.