Transfusion-related Acute Lung Injury in a Case of Ruptured Ectopic Pregnancy

Abstract

Ab s t r Ac t Aim: To highlight an uncommon complication of blood transfusion, which can be detected early based on suspicion, especially when the presentation is mild or atypical. Background: Transfusion-related acute lung injury (TRALI) is a rare complication of blood transfusion which can be life-threatening. TRALI is most commonly associated with plasma-containing blood products. The transfusion components can be fresh frozen plasma (FFP), whole blood platelet concentrates, and apheresis platelets and packed red blood cells. TRALI is thought to be caused by activation of recipient neutrophils by donor-derived antibodies targeting human leukocyte antigen (HLA). Case description: We are herewith presenting the case of a 26-year-old lady who was admitted with the diagnosis of ruptured ectopic pregnancy and a hemoglobin of 5.6 g%. Exploratory laparotomy was done, and she received three transfusions intra and postoperatively. After a few hours, we noticed that she was not maintaining SpO2 at room air. Chest X-ray showed infiltrates, and ECHO was normal. With the diagnosis of TRALI, she was started on nasal oxygen and was investigated. She responded well to injection hydrocortisone and diuretics and recovered within 72 hours. Conclusion: TRALI is a clinical diagnosis that should be considered in all patients who have respiratory difficulty and pulmonary insufficiency during or after transfusion. Timely recognition and adequate treatment are crucial in its management. Clinical significance: The classical presentation of TRALI includes onset of dyspnea and tachypnea within 6 hours of a transfusion. TRALI should be differentiated from transfusion-associated circulatory overload (TACO) and other transfusion reactions and also from cardiac conditions and pulmonary embolism. In mild cases, nasal oxygen administration is sufficient to achieve clinical improvement. In severe cases, mechanical ventilation may be necessary. Our patient responded well to hydrocortisone and diuretics and oxygen inhalation at 2 L/minute.