Case Series of Transfusion-Related Acute Lung Injury in a Tertiary Hospital and a Practical Comparison with the New Diagnostic Criteria

Abstract

Background: Transfusion-related acute lung injury (TRALI) is defined as acute respiratory distress syndrome with non-cardiogenic pulmonary edema caused by transfusion. It occurs only rarely but could result in patient mortality. TRALI has been declining since the successful adoption of TRALI risk mitigation strategies in several countries. The new diagnostic criteria were suggested in 2019 based on the knowledge and experience gained throughout the last decade. This article integrated a series of TRALI cases diagnosed in a tertiary hospital while reviewing each case based upon the new diagnostic criteria. Methods: Among the reported transfusion adverse reactions that occurred from March 2013 to June 2019, seven TRALI cases were recruited for this study. Each case was retrospectively reexamined with its clinical condition and transfusion history. The diagnosed cases were classified into TRALI subtypes newly suggested in the 2019 version. Results: The mean time interval to adverse reaction was 117 minutes (range: 7~370 minutes) and all satisfied the condition of hypoxemia and bilateral pulmonary infiltrations. The transfused blood components were apheresis platelets in three cases, platelet concentrates in one case, red blood cells in one case and combinations of different products in two cases. Five cases were diagnosed as possible TRALI, and all five cases were diagnosed as TRALI type 2 (2019 criteria). Conclusion: In our center, seven patients were diagnosed TRALI during the last 6 years. Screening more TRALI patients according to the new criteria, along with investigating the patients’ clinical characteristics, transfused blood components, treatments and integrated research, will facilitate Korean research on this field of medicine. (Korean J Blood Transfus 2019;30:219-229) acute lung injury; ARDS, acute respiratory distress syndrome; LAH, left atrial hypertension.