Transfusion-related acute lung injury (TRALI) | Lifeblood

TRALI is one of the most common cause of transfusion-associated fatalities. The true incidence is unknown but is reported to occur in about 1:10,000 units ... Skiptomaincontent Transfusion-relatedacutelunginjury(TRALI) Transfusion-relatedacutelunginjury(TRALI) Thisisanacute(<24hours)immunologicaltransfusionreaction.TRALIisaclinicaldiagnosis. Breadcrumbs Home Healthprofessionals ClinicalPractice Adverseevents Transfusion-relatedacutelunginjury(TRALI) Whentosuspectthisadversereaction Acuteonsetoffever,chills,dyspnoea,tachypnoea,tachycardia,hypotension,hypoxaemiaandnoncardiogenicbilateralpulmonaryoedemaleadingtorespiratoryfailureduringorwithinsixhoursoftransfusion.   TRALIhasbeenimplicatedintransfusionofplasma-containingcomponents(redcells,plateletsandplasma). TRALIisoneofthemostcommoncauseoftransfusion-associatedfatalities.Thetrueincidence isunknownbutisreportedtooccurinabout1:10,000unitstransfused. Usualcauses VariousmechanismshavebeenproposedforthepathogenesisofTRALI.Themostwidelyheldviewisthatpassivetransferof humanleucocyteantigen(HLA) or humanneutrophilantigen(HNA) antibodiesinthedonor’splasmaaredirectedagainstrecipientleucocyteantigens.Theresultingantigen-antibodyreactionactivatesneutrophilsinthelungmicrocirculation,releasingoxidasesandproteasesthatdamagebloodvesselsandmakethemleak.   Biologicalresponsemodifiers(BRM),suchasbiologicallyactivelipidscanaccumulateinsomecellularcomponentsduringstorageandmayberesponsibleforTRALIinsusceptiblepatients. Investigation TRALIhasmanyclinicalfeaturesincommonwithfluidoverloadorcardiogenicpulmonaryoedemaandthereforecarefulclinicalassessmentisrequired. Acutehaemolyticreaction or transfusion-associatedsepsis mayhavesimilarinitialclinicalfindings.Adirectantiglobulintest(DAT),fullbloodcountandrepeatABOgroupmaybeindicated.   AchestX-raywillshowbilateralinterstitialinfiltrates.   OnceTRALIisclinicallysuspected,testthedonorandrecipientserumforHLAandHNAantibodiesandperformaHLAtypeontherecipient.Iftheseantibodiesarepresent,itsupportsdiagnosisofTRALI. TRALItestingisspecialised,sopleasecontactLifebloodforfurthersupportandprovidethefollowingdetails:  observationsandsymptomsandtimeofonsetofsymptoms,and managementofthesuspectedTRALI. A Lifeblooddoctormaycontactyouforfurtherclarification. CollectbloodsamplesandsendthemtothenearestLifeblood tissuetypinglaboratory.Thesamplesshouldbelabelled“TRALIinvestigations”andkeptandsentatroomtemperature.   Pleasesend:  patientpre-transfusionserum,and patientpost-transfusionsamples:12mLserum(clot)and12mLEDTAorACD.   Whattodo Stopthetransfusionimmediatelyandfollowother stepsformanaging suspectedtransfusionreactions. Providecardiovascularandairwaysupport.Administersupplementaloxygenandemployventilationasnecessary.Diureticsarenotbeneficial. Thismaybecomeamedicalemergency;supportbloodpressureandmaintainanopenairway. AdviseyourTransfusionServiceProviderto contact Lifeblood, sowecanquarantineandtestrelatedcomponentsfromthesamedonorandpreventTRALIinotherrecipients. Reducingtheriskofantibody-mediatedTRALI Toreducetheriskofantibody-mediatedTRALI,donorswithapossibilityofhavingHLAorHNAantibodieseitherbecauseofahistoryofpregnancyortransfusion,arenotusedforplasmacomponentsorapheresisplatelets.   Thebelowaretwosignificantchanges LifebloodhasmadeaspartofitsTRALIRiskReductionStrategy.   1.Male-onlyplasma   Onlybloodorplasmafrom maledonorsisusedinthemanufactureofclinicalplasmacomponentssuchasfreshfrozenplasma(FFP)orcryoprecipitate.  2.Apheresisplateletscollectedfrommaledonors   TofurtherreducetheTRALIriskassociatedwithapheresisplatelets,Lifebloodhasmovedtoaplateletpheresispanelcomprisedofcisgendermaledonorsonly. Relatedresources AcuteTransfusionReactionsCard InformationSheet Download pdf,69KB Orderprintedcopies InvestigatingsuspectedTRALI Guide Download pdf,33KB Furtherinformation Relatedtopics iTransfuseApp Onlinelearning Adverseevents Adversetransfusionreactions:Acute Risksoftransfusion TRALI Backtotop X Back (-) Allresults (0) Popularpages Howtodonateblood Checkyoureligibility Createanaccount Frequentlyaskedquestions Latestcoronavirusupdates Searchourformsforhealthprofessionals Findadonorcentre Contactus