What are the hallmark features and initial management of transfusion-related acute lung injury (TRALI)?

What are the hallmark features and initial management of transfusion-related acute lung injury (TRALI)?

• A. Acute lung injury with hypoxemia during or within 6 hours of transfusion; stop transfusion, provide respiratory support, and notify the blood bank.
• B. Delayed fever and rash after transfusion; restart transfusion with slower rate.
• C. Mild shortness of breath; administer diuretics.
• D. Hypercoagulable state; begin anticoagulation immediately.

Answer: (A)

TRALI presents as acute lung injury with hypoxemia that occurs during or within 6 hours of a transfusion. The edema is noncardiogenic, so there are bilateral pulmonary infiltrates on imaging without evidence of left heart failure. The underlying mechanism involves donor anti-leukocyte antibodies or mediators in the transfused product that activate recipient neutrophils in the lungs, leading to capillary leak and pulmonary edema. The best initial management is to stop the transfusion immediately and provide respiratory support tailored to the patient’s needs (oxygen therapy, progressing to noninvasive or mechanical ventilation if required). Notify the blood bank so the implicated product can be identified and appropriate actions taken. Diuretics are not the frontline treatment since this is not primarily fluid overload, though they may be used if clinically indicated for other reasons; the priority is stopping the transfusion and supporting respiration and hemodynamics.

TRALI presents as acute lung injury with hypoxemia that occurs during or within 6 hours of a transfusion. The edema is noncardiogenic, so there are bilateral pulmonary infiltrates on imaging without evidence of left heart failure. The underlying mechanism involves donor anti-leukocyte antibodies or mediators in the transfused product that activate recipient neutrophils in the lungs, leading to capillary leak and pulmonary edema.

The best initial management is to stop the transfusion immediately and provide respiratory support tailored to the patient’s needs (oxygen therapy, progressing to noninvasive or mechanical ventilation if required). Notify the blood bank so the implicated product can be identified and appropriate actions taken. Diuretics are not the frontline treatment since this is not primarily fluid overload, though they may be used if clinically indicated for other reasons; the priority is stopping the transfusion and supporting respiration and hemodynamics.