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Transfusion Related Acute Lung Injury (TRALI)

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Transfusion of blood and blood products is associated with risks and they should only be administered when the benefits are considered to outweigh these risks. Adverse transfusion reactions occur with 0.5-4% of all transfusions. If a transfusion related adverse event occurs, this should be recorded on the appropriate notification form.

In this circumstance, please contact the Transfusion Nurse Specialist or the Transfusion Medicine Specialist. We emphasise the need for Haemovigilance, which is a national programme aimed at making blood transfusion safer. See also New Zealand Blood Transfusion Medicine Handbook 2008.

Definition

This is defined as new acute lung injury, with acute onset during or within 6 hours of completion of a transfusion, hypoxaemia, bilateral infiltrates on a CXR and no evidence of circulatory overload.

Pathophysiology

TRALI occurs when donor leucocyte antibodies react with patient leucocytes. It is more likely to be associated with plasma containing blood products. The implicated donors are mostly multiparous women with white cell antibodies.

Management

TRALI is a rare transfusion reaction but its recognition is vital. NZBS has implemented measures to reduce the risk of TRALI. These include the use of male only donors for FFP, cryoprecipitate and cryodepleted plasma. In addition, female plateletpheresis donors are screened for HLA antibodies.

If TRALI is suspected clinically the transfusion must be discontinued and management for respiratory failure instituted. The on call transfusion medicine specialist must be informed. They will advise on serological investigations as well as arrange donor investigations.

References

Transfusion Medicine Handbook 2008

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Document Control

  • Date last published: 01 December 2016
  • Document type: Clinical Guideline
  • Services responsible: National Child Cancer Network
  • Owner: Nyree Cole
  • Review frequency: 2 years