TRALI following fresh frozen plasma resuscitation from burn shock

•Fresh frozen plasma provides for safe and efficient resuscitation from burn shock.•Many severely burned patients have pre-existing ALI on admission.•The incidence of TRALI following FFP resuscitation from burn shock is low.

IntroductionResuscitation from burn shock using fresh frozen plasma (FFP) has been described. Critics of FFP resuscitation cite the development of transfusion related acute lung injury (TRALI) as a deterrent to its use. This study examines the occurrence of TRALI with FFP resuscitation of critically ill burned patients.MethodsA retrospective chart review was conducted of severely burned patients who received FFP resuscitation. Data points included age, TBSA, TBSA full thickness, presence of alternate etiologies of acute lung injury, total FFP administered, and signs and symptoms of TRALI as defined per the Canadian Blood Services Consensus Conference.ResultsEighty-three patients met the definition of severe burn and received FFP resuscitation. Of those, 65 met exclusion criteria. Eighteen patients were left for analysis with only one found to have signs and symptoms of TRALI. That patient suffered a 53.5% TBSA burn, received a total of 6228 ml FFP, had no competing etiologies of ALI, and was diagnosed with TRALI within 6 h of completing the FFP transfusion.ConclusionThe possible occurrence of TRALI in burn patients receiving FFP resuscitation should be weighed against the reported benefits of such a resuscitation strategy.