Definition and Epidemiology

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The page below is a sample from the LabCE course Transfusion Reactions. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Definition and Epidemiology

Transfusion-associated acute lung injury (TRALI) is a complication of blood transfusion that results in shortness of breath due to pulmonary edema, fever, and hypotension. The pulmonary edema is noncardiogenic which means it does not originate from the heart. TRALI is a severely life-threatening adverse reaction. Symptoms manifest within 6 hours of transfusion.
Products typically implicated in TRALI are Whole Blood, Red Blood Cells, Fresh Frozen Plasma, Cryoprecipitate, and Platelets. There is a higher proportion of these reactions with plasma and platelet units from multiparous women donors. Consequently, donor centers now prepare plasma from male donors or from female donors that have been tested for HLA antibodies.
The AABB Blood Bank and Transfusion Service Program addresses TRALI mitigation in its standard, which reads:
"Plasma, Apheresis Platelets, and Whole Blood for allogeneic transfusion shall be from males, females who have not been pregnant, or females who have been tested since their most recent pregnancy and results interpreted as negative for HLA antibodies.
The standard applies to plasma and whole blood collected and prepared after April 1, 2014 and for platelets collected after October 1, 2016."

*Reference: Standards for Blood Banks and Transfusion Services. 30th ed. Bethesda, MD: AABB; 2016.