Transfusion-related Acute Lung Injury: 36 Years of Progress (1985-2021)

Area of Science:

• Transfusion Medicine
• Critical Care Medicine
• Pulmonary Medicine

Background:

• Transfusion-related acute lung injury (TRALI) was defined in 1985 as acute respiratory distress syndrome (ARDS) post-transfusion without other risk factors.
• TRALI was a leading cause of transfusion-related death in the U.S. and has been reduced through strategies like using male-predominant plasma.

Purpose of the Study:

• To review the history and current understanding of TRALI.
• To address ongoing challenges including non-antibody mechanisms, TRALI in massive transfusion, unusual cases, and diagnostic accuracy.
• To introduce updated terminology for TRALI diagnosis.

Main Methods:

• Review of historical data and reported cases of TRALI.
• Analysis of studies on TRALI mechanisms and risk factors.
• Examination of diagnostic accuracy and proposed consensus definitions.

Main Results:

• Significant progress has been made in reducing TRALI incidence.
• A 2013-2015 study revealed frequent misdiagnosis of TRALI in U.S. hospitals.
• A 2019 consensus panel proposed TRALI types I and II for transfusion-likely causes, distinguishing them from other ARDS cases.

Conclusions:

• Accurate TRALI diagnosis requires distinguishing hydrostatic from permeability pulmonary edema.
• Expert evaluation is crucial to identify ARDS risk factors and assess patient stability before transfusion.
• Newer diagnostic criteria necessitate critical care or pulmonary expertise for precise TRALI classification.