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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 Unit has developed a standard for the Standards for Blood Banks and Transfusion Services, 29th ed that addresses TRALI mitigation. The standard (* reads:
Plasma 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 collected and prepared after April 1, 2014. Components addressed by this standard include:
  • Fresh Frozen Plasma (FFP) prepared from whole blood
  • FFP collected by apheresis (collected alone or concurrent with a cellular component such as platelets)
  • Plasma, Cryoprecipitate-Reduced
  • Plasma, Frozen Within 24 Hours of Phlebotomy (PF24)
  • Thawed plasma from any of the products listed above
  • Liquid Plasma
  • Whole Blood (if designated for transfusion as Whole Blood)
*Reference: Levitt J. ed. (for AABB Blood Bank/Transfusion Service Standards Program Unit). Standards for Blood Banks and Transfusion Services, 29th ed. Bethesda, MD: AABB, 2014.