TRALI

Transfusion-Related AcuteLung Injury (TRALI) is a serious and potentially life-threatening complication of blood transfusion. It is characterised by sudden respiratory distress, low blood oxygen levels, and non-cardiogenic pulmonary oedema occurring during or within six hours after transfusion. TRALI can develop after the administration of plasma-containing blood components, including red blood cells, platelets, and fresh frozen plasma.

The condition is commonly associated with immune-mediated reactions in which antibodies or biologically active substances activate neutrophils within the pulmonary circulation. This causes inflammation and damage to the lung capillaries, allowing fluid to leak into the alveolar spaces. In some patients, non-immune factors such as infection, surgery, trauma, or systemic inflammation may increase susceptibility.

Typical symptoms include rapid breathing, shortness of breath, cough, fever, low blood pressure, and cyanosis. Chest imaging may demonstrate bilateral pulmonary infiltrates consistent with pulmonary oedema, without evidence of circulatory fluid overload.

Treatment is mainly supportive, with immediate cessation of the transfusion, oxygen therapy, and ventilatory support when required. Diuretics are generally not beneficial unless circulatory overload is also present. Prevention involves careful blood-component management, appropriate donor selection, and recognition of patients at increased risk. Prompt diagnosis and treatment are essential for improving outcomes and reducing complications.