Acronym for Transfusion-Related Acute Lung Injury.

The causes of post-transfusion morbidity are, by order of frequency: 

-        TRALI, 

-        ciculatory overload (TACO acronym for Transfusion-Associated Circulatory Overload), 

-        hemolytic reaction 

-        febrile reaction of non-hemolytic origin, 

-        alloimmunisation and immunomodulation (important in case of cancer surgery). 

The British 2009 SHOTreport (Serious Hazards Of Transfusion) showed that the number of transfusion-related complications  amounts to 13/100,000 in adults, 18/100.000 patients under 18 years and 37/100,000 in infants less than one year. TRALI is an overlooked complication in children because its diagnosis is difficult during anesthesia or the postoperative period; it is however the first cause of morbidity and mortality related to the transfusion of blood components in France. Its impact in a large American Pediatric Center was estimated at 1.2 % of all transfusions. This lung damage could be due, in the majority of cases, to the presence of antibodies from the donor against some antigens of the leukocytes of the receiver with formation of aggregates of leukocytes and platelets in the lung capillaries. Prior accumulation of leukocytes in the capillaries could be a promoting factor, as well aq the accumulation of fat in the transfused blood during its conservation. The incidence of TRALI has declined since the generalized use of leukoreduced red blood cells and plasma from male donors or from women who have never been pregnant.

Clinical picture: pulmonary injury edema with progressive deterioration of oxygenation (PaO2/FiO2 ≤ 300) appearing within 6 hours after transfusion, and associated with fever and hemodynamic disorders without any signs of cardiac failure. 

Anesthetic implications:

diagnosis to be kept in mind in case of hypoxemia occurring within 6 hours after transfusion of blood components, including plasma and platelet concentrates.

References :

-        Lavoie J.
Blood transfusion risks and alternative strategies in pediatric patients.
Pediatr Anesth 2011; 21:14-24.

-        Ririe DG, Lantz PE, Glazier SS, Argenta LC.
Transfusion-related acute lung injury in an infant during craniofacial surgery.
Anesth Analg 2005; 101:1003-6.

-        Ozier Y.
Le TRALI: un diagnostic clinique.
Ann Fr Anesth Réanim 2007; 26:835.

-        Thalji L, Thum D, Weister TJ, Weber WV et al.
Incidence and epidemiology of perioperativr transfusion-related pulmonary complications in pediatric noncardiac surgical patients : a single-center, 5-year experience.
Anesth Analg 2018 ; 127 : 1180-8.

Updated: November 2018