Case report: transfusion-related acute lung injury (TRALI) - a clear and present danger

To describe a case of transfusion-related acute lung injury (TRALI) after platelet transfusion immediately following cardiac surgery, and to review the clinical features, pathophysiology, management, and morbidity and mortality associated with such an event.

A 62-yr-old man was transferred to our centre for urgent coronary artery bypass grafting in the setting of recent anti-platelet medication use. Soon after surgery he received platelet transfusions despite having only moderate blood loss. Shortly following the platelet transfusion, he suffered acute hypoxic and hypotensive decompensation requiring nitric oxide therapy, inotropic support, and prolonged need for mechanical ventilation. The patient was eventually discharged from the intensive care unit nine days following the event. The diagnosis of TRALI was made by clinical and radiographic criteria.

Transfusion-related acute lung injury is now the leading cause of transfusion-related fatalities. Early diagnosis of TRALI is important and these reactions should be reported to the blood transfusion service so that appropriate action can be taken to prevent future morbidity and mortality in other patients. To reduce serious transfusion reactions, inappropriate transfusions must be minimized and the decision to transfuse blood products should be taken with care.