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Prevention of Transfusion-Related Acute Lung Injury (TRALI)

The AABB has made several recommendations for preventing TRALI including:

  • Blood collection facilities should implement interventions to minimize the preparation of high-plasma-volume components from donors known to be leukocyte-alloimmunized or at increased risk for leukocyte alloimmunization.
  • Blood transfusion facilities should work toward implementing appropriate evidence-based hemotherapy practices to minimize unnecessary transfusion.
  • Blood collection and transfusion facilities should monitor the incidence of reported TRALI and TRALI-related mortality.

Transfusion services should work with clinicians to educate providers about the risks of TRALI and about the need to work toward implementing evidence-based transfusion practices for all blood components, with special emphasis on high plasma-volume components. High-plasma-volume components include the following:

  • FFP obtained from whole blood or apheresis
  • Plasma frozen within 24 hours
  • Cryoprecipitate-reduced plasma
  • Apheresis platelets
  • Whole blood

There have been several other suggestions for preventing TRALI, which include:

  • Screening of all donors for anti-neutrophil or anti-HLA antibodies. Once donors are identified, they are excluded from donating, or their blood is used for products that do not contain much plasma. This method would not prevent TRALI in recipients who have alloantibodies.
  • Use of pre-storage leukoreduced blood. Use of younger blood products.
  • Appropriate utilization of blood products. Using blood products only when clinically indicated may reduce the frequency of TRALI.
Because TRALI can coexist with other transfusion reactions and with pulmonary complications unrelated to transfusion, the diagnosis of TRALI is difficult, but it is an important step in monitoring the effectiveness of TRALI risk-reduction strategies.