TRALI (Transfusion Related Acute Lung Injury)

Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
54 of 86 patients (63%) with a mean age of 67.6 years old undergoing extensive surgery developed respiratory failure (PaO2/FiO2 <300mmHg) after intraoperative apheresis platelet transfusion. Five cases diagnosed as possible TRALI (5.8%) based on permeability pulmonary edema on chest x-rays and timing within 6 hours. Multivariate logistic regression showed presence of anti-granulocyte antibody in the transfused platelets as significant independent predictor of possible TRALI (OR=13.0).
Time to detection: 
< 6 hours
Alerting signals, symptoms, evidence of occurrence: 
Active surveillance within 6 hours of platelet transfusion. Respiratory failure defined as PaO2/FiO2 <300mmHg. Independent. All enrolled patients had chest xrays evaluated by independent radiologist for the presence of permeability pulmonary edema or hydrostatic pulmonary edema.
Demonstration of imputability or root cause: 
Consensus Conference criteria used; all patients had extensive surgery (an ALI factor), hence possible TRALI.
Suggest references: 
Kanai R, Iijima T, Hashimoto S, et al. Impact of immunoreactive substances contained in apheresis platelet concentrate on postoperative respiratory function in surgical patients receiving platelet transfusion: a prospective cohort study. Transfus Med. 2013 Oct;23(5):344-50