Transfusion-related acute lung injury: a life-threatening transfusion reaction

We present the case of a 57-year-old woman who developed transfusion-related acute lung injury (TRALI) following a transfusion of packed red blood cells (pRBCs).

A 56-year-old woman had undergone a low anterior resection in 2002 because of a Duke's stage D adenocarcinoma of the rectum. In June 2003 she was referred to our department, presenting symptoms and signs of ileus. Abdominal radiograph revealed multiple air-fluid levels, while a computed tomography scan showed disease dissemination. Colonoscopic control verified recurrent disease in the anastomotic area. At surgery, a palliative loop ostomy was generated. In the 4(th) postoperative day it was decided that one unit of pRBCs be transfused. pRBC administration complicated with a severe reaction, developing within 35 minutes of the transfusion episode. The diagnosis of TRALI syndrome was based on clinical signs and symptoms. Hemodynamic stabilization and resuscitation required low doses of epinephrine, diuretics, and a high concentration of inspired oxygen in combination with bronchodilators. Ventilatory assistance was not required. Clinical improvement occurred 12 hours later. Full recovery of the syndrome was observed in 6 days, while chest X-ray returned to normal findings within 4 days.

TRALI syndrome is an immune-mediated transfusion reaction which can cause severe complications or even death. Early diagnosis and treatment improves survival and usually results in full recovery. TRALI remains a clinical diagnosis in an appropriate setting, supported by serologic studies if these are available.