[Unclear acute respiratory failure in a 64-year-old woman after coronary intervention]

Due to a retroperitoneal hematoma after cardiac catheterization a 64 year-old woman received two concentrates of red blood cells. Within two hours after transfusion the patient developed acute dyspnoea, anxiety and shivering.

Computertomography (CT) of the chest revealed a new bilateral, basally accented pulmonary edema. Pulmonary embolism was ruled out. A cardiac cause in terms of cardiogenic shock had been excluded by echocardiography and other non-invasive measurements. Moreover, no circulatory overload (transfusion-associated circulatory overload [TACO]) after transfusion was presented and the stable size of the retroperitoneal hematoma excluded haemorrhagic shock. Hence, the clinical pattern pointed towards a transfusion-related acute lung injury (TRALI).

The patient was intubated and a catecholamine medication was initiated. The weaning process proceeded without complications and the patient was extubated after several days. In the following chest x-ray no pulmonary residuals were left. After two weeks the patient was transferred to a rehabilitation unit.

TRALI is a life-threatening and an often unconsidered complication after transfusion of plasma containing blood products. According to the criteria of the european haemovigilance networks (EHN-criteria), TRALI is diagnosed by clinical and radiological parameters. In case of suspicious TRALI the involved transfusion center has to be informed. By a crossmatch between donor plasma and recipient granulocytes the causal antibodies are detected in most cases. In 17% of cases no antibodies are detected.