Transfusion related lung injury. TRALI

SummaryTransfusion related lung injury is almost certainly related to the administration of blood products containing antibodies in the plasma. Those antibodies may have developed during pregnancy or following blood transfusion. They react with specific ‘cognate’ antigens in the recipient and in some patients, but not all, this results in an acute lung injury pattern. The problem resides in the plasma, so the incidence with FFP is far higher than with red cells.Blood transfusion services have adopted several ways of reducing risk such as using untransfused male donors. Leucodepletion may also have a benefit.Diagnosis is an issue as it is easily confused with transfusion associated circulatory overload TACO and often the right preconditions exist for both. Although most sources agree that the condition usually occurs within 6 h of transfusion some new information from critically ill patients has suggested that a condition called ‘delayed TRALI’ may exist, but this is currently contentious.The natural history of the condition is extremely variable and there is an associated mortality, 5–10%. Most patients do require ventilation but most do well.