Mrs. R.W.

Mrs. R.W.

It is likely that Ms. R.W. has suffered a TRALI.
Transfusion-related acute lung injury (TRALI) is an acute respiratory distress syndrome secondary to transfusion of blood products and causes hypoxia and bilateral non-cardiogenic pulmonary edema. Its incidence is not precisely known, but is estimated between 1 in 1200 and 1 in 5000.
Symptoms include dyspnea, hypoxemia, hypotension and fever. There is no evidence of CHF – there is no jugular venous distension and right arterial pressure is normal.
The etiology of TRALI is unclear, however it is believed that there is either a transfer of biologically active lipids or a transfer of HLA/granulocyte antibodies from the donor to the recipient. (It is believed that multiparous female donors have an increased number of these antibodies as a result of previous pregnancies, and therefore receiving blood from these donors poses a greater risk of developing TRALI.)
Management of this type of transfusion reaction includes cessation of the transfusion, maintenance of the IV line with normal saline, as well as supportive care including oxygenation or mechanical ventilation, if necessary. CXRs must be performed and the blood bank notified. Steroids and diuretics are NOT indicated in the treatment of TRALI.